Anatomy Flashcards

Question 1

Q

1)Triangles of the neck

2) Structures within triangles

Answer

A

1) Anterior - Horizontal ramus of mandible, Midline, SCM

Posterior - middle 1/3 Clavicle, trapezius, SCM,

Roof - Investing Fascia

Floor - Prevertebral fascia

2) Anterior -

Muscles - Supra + (Stylohyoid, digastric, myohyoid, geniohyoid) Infra (Omohyoid, sternohyoid, sternothyroid, thyrohyoid) hyoid muscles

Vascular - CCA, Carotid bifurcation, IJV

Nerves- VII, IX, X, XI, XII

Posterior -

Muscles - Omohyoid (Inferior belly), Vertebral muscles (scalenes, splenius, capitis, levator scapulae)

Vascular - EJV (empties into SCV), Subclavian Art (between ant. and mid. scalen) + Vein, Transverse Cerv. Art + Vein, Suprascapular ARt + Vein

Nerves - CN XI, Cervical Plexus, Phrenic Nerve, Brachial Plexus

Question 2

Q

1) Subdivisions

2) Contents

Answer

A

1) Carotid - Posterior belly of digastric, Medial border of SCM, Superior belly of omohyoid

Submental - midline, Anterior belly of digastric, hyoid bone

Submandibular - Anterior belly of digastric, Posterior belly of digastric, mandible

Muscular - Hyoid, omohyoid + SCM, Midline

2)

Muscles - Supra + (Stylohyoid, digastric, myohyoid, geniohyoid) Infra (Omohyoid, sternohyoid, sternothyroid, thyrohyoid) hyoid muscles

Vascular - CCA, Carotid bifurcation, IJV

Nerves- VII, IX, X, XI, XII

Question 3

Q

1) Subdivisions

2) Contents

Answer

A

1) Occipital Triangle- SCM, trapezius, Inf. belly of omohyoid

Subclavian triangle - SCM, mid 1/3 clavicle, Inf. belly of omohyoid

2)

Muscles - Omohyoid (Inferior belly), Vertebral muscles (scalenes, splenius, capitis, levator scapulae)

Vascular - EJV (empties into SCV), Subclavian Art (between ant. and mid. scalen) + Vein, Transverse Cerv. Art + Vein, Suprascapular ARt + Vein

Nerves - CN XI, Cervical Plexus, Phrenic Nerve, Brachial Plexus

Question 4

Q

Suprahyoid Muscles

Name them, their attachments and innervation

Answer

A

1) Stylohyoid

Styloid process of temporal bone –> lateral hyoid

Innervated by a branch of CN VII

2) Digastric

2 bellies.

Anterior (Inferior Alveolar Nerve - CNV3) - digastric fossa of mandible.

Posterior (Facial Nerve) - styloid process of temporal bone.

Two bellies communicate via intermediate tendon which is trapped by a fibrous sling on thy hyoid bone.

3) Mylohyoid

Mylohyoid line of mandible –> hyoid bone.

Innervation from Inferior Alveolar Nerve of CNV3

4) Geniohyoid

Mental spine of mandible –> hyoid bone

C1 Nerve roots (Travel with CNXII)

Question 5

Q

Infrahyoid Muscles

name them, their attachments and their innervations

Answer

A

Blood supply from Sup. + Inf. Thyr. Arteries

DEEP

1) Thyrhoyoid

Thyroid cartilage –> hyoid bone

Innervated C1 (travels within CNXII)

2) Sternothyroid

Manubrium –> thyroid cartilage

Innervated by Ansa Cervicalis (C1-C3)

SUPERFICIAL

3)Sternohyoid

Sternum/SCJ –> hyoid bone

Innervated by Ansa Cervicalis (C1-C3)

4) Omohyoid

Scapula (Inferior belly) –> hyoid (superior belly) via intermediate tendon anchored to deep cervical fascia

Innervated by Ansa Cervicalis (C1-C3)

Question 6

Q

Submandibular Gland

1) Structures at risk during excision + deficit
2) Innervation

Answer

A

1) Lingual Nerve - Ipsilateral taste / sensation loss of anterior 2/3 tongue

Hypoglossal Nerve - Ipsialteral paralysis of the tongue

Facial Nerve (marginal Mandibular branch) - Ipsilateral weakness of lower lip and chin

2) Parasympathetic - CNVII –> Chorda tympani –> Then travels with lingual nerve before synpasing at submandibular ganglion. More volumous secretions

Sympathetic - Superior Cervical Ganglion then plexus follows arteries. Less volumous more enzyme rich secretions.

Question 7

Q

1) Extrinsic Muscles (attachments + Innervations)

2) Intrinsic Muscles (Innvervations)

Answer

A

1) Extrinsic:

Genioglossus - Mandible –> Hyoid (+all of tongue)

Innervated by CN XII

Hyoglossus - Hyoid –> tongue (CN XII)

Styloglossus - Styloid process –>tongue (CNXII)

Palatoglossus - Palatine aponeurosis –> tongue (CNX)

2) Intrinsic Muscles

Superior longitudinal, inferior longitudinal, transverse + vertical

All innervated by CNXII

Question 8

Q

Muscles attaching at 1-8

Ligaments 9-11

Answer

A

1 - Suprapinatous 2 - subscapularis 3 - Biceps (short) + Corachobrachialis

4 - Pec Minor 5 - Omohyoid 6 - Serratus Anterior

7 - Subscapularis 8 - Triceps (long)

9 - Coracohumeral ligament 10- coraco-acromial ligament 11 - suprascapular ligament

Question 9

Q

Muscles 1 -14

ligament 15

Answer

A

1. Infraspinatous 2. Levator Scapulae

3. supraspinatous 4. Trapezius 5. Deltoid

6 Supraspinatous 7 Infraspinatous 8 Teres Minor

9 Long head triceps 10+11 - Teres Minor

12 - Teres Major 13 - Lat Dorsi 14 - Rhom. Major

15. Inferior Scapular Ligament

Question 10

Q

1) Long head biceps

2) Trapezius (Attach/Innervation)

3) Lat Dorsi (Attach/Innervation)

4) Levator Scapulae (Attach/Innervation)

5) Rhomboids (Attach/Innervation)

Answer

A

1) Supraglenoid tubercle travels within the capsule

2) Skull, nuchal ligament + C7-T12 Spinous processes –> Acromion, Scapular spine + clavicle

Accessory Nerve

3) Spinous Processes T7-T12, iliac crest, inferior three ribs + lumbar fascia –> Intertubercular sulcus of humerus

Thoracodorsal nerve

4) C1-C4 spinous processes –> Medial scapular border.

Dorsal Scapular Nerve

5) C7-T1(Minor) T2-T5 (major) –> medial scapula

Dorsal scapular nerve

Question 11

Q

1-9

Answer

A

1. Piriformis 2. glut. max 3. Quadr. Femori

4- origin of semitendinosus, biceps femoris

5 - gracilis 6 - semitendinosus 7. semimembranosus

8. Gracilis 9. Long head of biceps femoris

Question 12

Q

10-19

Answer

A

10. Sciatic Nerve 11 Post. Cutaneous Nerve of thigh

12 ischial tuberosity 13 poplit. artery

14. polit. vein 15. SSV

16. Tibial Nerve 17. Common peroneal Nerve

18. Peroneal communicative nerve 19. sural nerve

Question 13

Q

1-15

Answer

A

1. Piriformis 2. Quadratus Femoris

3. Origin of semitendinosis/ bicep fem. 4. Gracilis

5. Long head bicep fem. 6 Semitendinosis

7. Short head bicep fem. 8. Semimebranosous

9. Post. Cut. Nerve of thich 10. Sciatic Nerve

11. Ischial Tuberosity 12. Pop. ARt.

13. Pop. Vein 14. Srural Nerve 15. SSV

Question 14

Q

Name all muscles, attachment and innervation of anterior thigh

Blood Supply

Answer

A

Sartorius - ASIS –> Medial tibia (pes anserius) femoral nerve

Pectineus - Anterior pelvis (pectineal line) –> posterior femur (pectineal line) femoral/obturator nerve

Psoas Major - Lumbar vertebrae has common tendon with iliacus –> lesser trochanter of femur (L1-L3 nerve roots)

Iliacus - Iliac fossa has a common tendon with psoas maj. —> lesser trochanter of femur (femoral nerve)

Quadriceps Muscles: (common insertion onto patella via quadriceps tendon) femoral nerve

Rectus Femoris - Ridge of iliac portion of acetabulum (superior to acetabulum)/ anterior inferior iliac spine

Vastus Medialis - Intertrochanteric line/medial linea aspera

Vastis intermedius - Anterior/Lateral Femoral Shaft

Vastus Lateralis - Greater trochanter/lateral linea aspera

Profunda Femoris

Question 15

Q

Name all muscles, insertions and innervations of the posterior thigh

Blood Supply

Answer

A

Hamstrings -

Biceps Femoris -

Long head - Ischial tuberosity. tibial portion of sciat.

Short head - Linea aspera. fibular portion of sciat.

Common tendon inserts to head of fibula

Semitendinosus - ischial tuberosity to medial tibia. tibial portion of sciat.

Semimembranosus (deep to semitend.) - ischial tuberosity to medial tibial condyle. tibial portion of sciat.

Blood Supply - Inferior gluteal artery + profunda femoris artery

Question 16

Q

Name all muscles, insertions and innervations of the medial thigh

Blood Supply

Answer

A

Adductor Magnus

Adductor port. - Inferior pub. rami + ischial rami –> linea aspera. obturator nerv.

Hamstring portion - Ischial tub. –> extends distally attaching to supracondylar line of fem. + adductor tubercle. tibial port. of sciatic n.

Adductor Longus -Pubis –>linea aspera. obturator n

Adductor Brevis (beneath longus)- pubis + inf. pubic rami –> linea aspera (prox. to longus) obtur. nerv.

Obturator Externus - obturator foramen –> post. aspect of greater. troch. obturator nerve

Gracilis - pubis + inf. pub. rami –> pes anserius (in between sartorius and semintendinosis) obturator nerve.

Blood supply - Obturator artery + perforating branches of the profunda femoris

Question 17

Q

1-11

Answer

A

1. Pec Minor 2. deltoid 3. Pec major

4. Triceps 5. Biceps (long) 6. Biceps (short)

7. Corachobrachialis 8. Teres Major 9. Subscapularis

10. Lat. Dorsi 11. Serrat. Ant.

Question 18

Q

Question 19

Q

12- 19

Answer

A

12. lat 1/3 clavicle 13. Axillary Vein.

14. Thoracoacromial Trunk

15. Circumflex scapular artery

16. Subscapular Art. 17. Axillary Artery

18. Thoracodorsal artery 19. Brachial Art.

Question 20

Q

20-28

Answer

A

20 - Medial Cord 21 - Lateral Cord

22- Musculocutaneous n. 23 - Median n.

24 - Radial n.

25. thoracodrosal n. 26. median n.

27. Ulna N. 28. Medial cutaneous n. of forearm

Question 21

Q

i) Gross heirarchy
ii) Describe formation from spinal cord to the plexus
iii) Describe derivatives of trunks
iv) Describe contributions to the cords and relative positions

Answer

A

i) Roots > Trunks > Divisions > Cords > Branches

ii) Derived from anterior rami of C5-T1 spinal nerves. They pass in between the anterior and medial scalene muscles just superior to the subcalvian artery

iii) Superior - C5-C6

*Middle** - C7
*Inferior -** C8-T1

Trunks cross laterally through the posterior neck triangle

iv) Cords are named relative to axillary artery. Trunks divide into ant. and post. divisions and enter axilla.

Lateral - Anterior Division of Superior + Middle Trunk

Posterior - Posterior Division of all trunks

Medial - Anterior Division of Inferior Trunk

Question 22

Q

Brachial Plexus 2

i) Major Branches of the brachial plexus

ii) Minor branches of the brachial plexus and where they come from

Answer

A

i)

Lateral Cord - Musculocutaneous Nerve (C5-C7)

Posterior Cord - Axillary Nerve (C5-C6), Radial Nerve (C5-T1)

Medial Cord - Ulnar Nerve (C8-T1)

Medial + Lat. Cords - Median Nerve (C5/6-T1)

ii)

Roots - Dorsal Scap. Nerv (C5 - Rhomboids)

Long Thor. Nerve (C5-7 - Serratus Ant.)

Trunks - Suprascap. Nerv. (Upper Trunk- Supra+ Infraspinatus)

Nerve to Subclavius (Upper Trunk - subclavius)

Lat. Cord - Lat. Pect. Nerv. (Pec Major)

Med. Cord - Med. Pect. Nerv (Pec Min. + Maj)

Med. Cut. Nerve of forearm

Med. Cut. Nerve of arm

Post. Cord - Thoracodorsal Nerv. (Lat. Dorsi)

Sup. Subscapular Nerv. (subscapularis)

Inf. Subscapular Nerv. (Teres Maj. + subscapularis)

Question 23

Q

The Axilla:

i) Boundaries

ii) Passageways exiting the axilla

iii) Contents of axilla

Answer

A

i)

Apex - Posterior clavicle, Sup. Scapula, First Rib

Latera- Intertubercular groove of humerus

Medial - Serratus anterior + thoracic wall

Posterior - lat dorsi, teres maj., subscapularis

anterior - pec major, minor, subclavius

ii)

1) Exit into upper arm (Lat. and inf.)
2) Qaudrangular Space

Lat. - Humerus, Med. - Triceps long head, sup. - teres minor. inf. - teres major

Transmits - Axillary n., post circumflex humeral vessels

3) Clavipectoral Triangle

Inf - pec Major Sup Lat. - Deltoid, Sup Med. - Clavicle

Transmits - Cephalic Vein, Deltoid branch of thoracoacromial art.

4) Lateral Triangular Space

Sup - Teres Maj Lat - Humerus med - Long head triceps

Transmits - Radial Nerve, Pronfuda brachii artery

iii) Axillary Contents:

Axillary artery + branches
Axillary veins + tributaries
Axillary LNs
Biceps (short) head, and corachobrachialis

Question 24

Q

Subclavian Artery

i) Gross route
ii) Branches

Answer

A

i) R- arises from brachiocephalic trunk. RLN winds around this on the right side

L - Directly from aortic arch

1st part - Aorta –> Anterior Scalene

2nd part - Posterior to anterior scalene

3rd part - Anterior scalene to first rib

ii) VIT CD

1st -

Vertebral (Enter C6 transverse process travelling superiorly through foramen transversarium before enterring foramen magnum where they unite)

Internal Thoracic Artery (Intercostal branches, breast perforators, terminates as superior epigastric)

Thyrocervical trunk ( Inferior thyroid, Suprascapular, transverse cervical art.)

2nd - Costocervical Trunk (Sup. intercosta, deep cervical)

3rd Dosal Scapular Artery

Question 25

Q

Axillary Artery

i) Gross Route
ii) branches

Answer

A

i) Continuation of subclavian art. as it passes border of first rib. beomes the brachial artery after the lower border of teres major

Divisible into three parts

1st part - Proximal to pec minor

2nd part - Posterior to pec minor

3rd part - Distal to pec minor

ii) Screw the Lawyer, Save a patient

1st part - Superior Thoracic Artery

2nd part - Thoracoacromial artery (Pectoral, Acromial, Clavicular + Deltoid)

Lateral Thoracic Artery

3rd Part - Subscap. art.

Ant. + Post. Circumflex arteries

Question 26

Q

Ear

i) Middle Ear Muscles
ii) Parasympathetic Nerves running through/near ear

Answer

A

i) Tensor Tympani - Auditory tube –> handle of malleus

Mandibular Nerve V3

Dampens sounds

Stapedius - Pyramid walls –> Stapes

VII

Stabilises of stapes

ii) CNVII - Parasympathetic nerves to lacrimal glands.

Gives off the greater petrosal nerve to the pterygopalatine ganglion. From here postganglionic fibers travel with V2 branches to reach nasolacrimal glands/epithelium.

Gives off the chorda tympani (joins lingual nerve) which synapses with the submandibular ganglion and innervates submandibular gland.

CNIX - Tympanic branch innervates tympanic plexus. CNIX fibers then form lesser petrosal nerve synapsing with the otic ganglion. postganglionic fibers then travel with auriculotemporal nerve (V3 Branch) to innervate parotid + sublingual glands.

Question 27

Q

Label 1-13

Answer

A

1. Helix 2. Scapha 3. Tubercle 4. Antihelix

5. Antitragus 6. Earlobe 7. Tragus

8. Intertragic Notch 9. External Meatus (cartilage)

10. Crus of helix 11. Crus of antihelix

12. Triangular fossa 13. Mastoid Process

Question 28

Q

Label 14-25

Answer

A

14. Mallues 15. Incus 16. Stapes

17. Manubrium 18. Malleus 19. Pars Flaccida

20. Chorda Tympani 21. Incus 22. Umbo

23. Pars tensa 24. Annulus Fibrosis 25. cone of light

Question 29

Q

Grossly Describe External Ear

i) Visible

ii) Describe external accoustic meatus

iii) Tympanic Membrane

iv) innervation of the external ear

Answer

A

i) Auricle - Visible part of the ear.

Upper auricle is cartilagenous while the lobe is not cartilagenous.

Helix is the outer cartilagenous rim of auricle while the anti-helix is the inner cartilagenous rim

Concha- Depression in middle ear continuing into the external accoustic meatus

Tragus and anti-tragus - immediately at entry to the external accoustic meatus

ii) External accoustic meat. runs from concha to the tympanic membrane in an s shape. external 1/3 - cartilaginous whereas the internal 2/3 are formed by the temporal bone

iii) Tympanic memb. - Connected to temporal bone by fibrocartilagenous ring.

Handle of malleus attaches at umbo. Pars tensa spreads radially from the handle of malleus whereas pars flacidda is superior to the handle

iv)

Cervical Plexus - Greater auricular nerve + Lesser occipital nerve both supply skin of auricle

Auriculotemporal nerve (CNV3), Facial Nerve + Vagal nerve supply skin of auricle and external accoustic meatus

Question 30

Q

Middle Ear

i) Gross Description
ii) Borders
iii) Bony components

Answer

A

i) Begins at tympanic membrane. Medially is the tympanic cavity whereas superiorly is the epitympanic recess (next to the mastoid air cells)

Eustachian tube connects middle ear (ant. wall) to nasopharynx (lat. wall).

ii)

Roof - Petrous temporal bone adjacent to middle cranial cavity

Floor - Petrous temporal bone. IJV adjacent

Lateral wall- Tympanic Membrame

Medial wall - Laterally borders inner ear. Facial Nerve Bulge

Anterior Wall - Two openings - Auditory tube + tensor tympani. ICA adjacent

Posterior Wall - Adjacent to mastoid cavity. Mastoid aditus allows communciation between middle ear and mastoid air cells

iii) Bony components transmit sound from tympanic membrane to the oval window

Malleus–> Incus–> Stapes

Question 31

Q

INner Ear

i) Gross anatomy
ii) Describe balance organs
iii) Describe auditory organs

Answer

A

i) Grossly the inner ear is comrpised of the

- bony labyrinth, in the petrous bone formed by cochlea, vestibule (cochlea is anterior and semi circular canals are posterior) and 3 semi-circular canals. Lined by perilymph

membranous labyrinth is within the bony labyrinth. It is formed from saccule, 3 semi-circular ducts, cochlea duct and utricle. Lined by endolymph
oval window is between middle ear and vestibule, round window is betwene the middle ear and part of the cochlear duct
iii) Cochlea houses the cochlea duct. Modiolus is central portion of bone in cochlea which communicates with CN VIII. Spiral Lamina portion of cochlea holds teh cochlea duct in place.

Scala vestibuli superior to each cochlea duct (seperated from each other by reissner’s membrane) and scala tympani inferiorly (seprated by basilar membrance which houses organs of corti [specialised accoustic epithelium]). Basement membrane essentially are the receptors of CNVIII.

iii) Saccule and Urticle in the vestibule responsible for balance. saccule - vertical movement recevies the cochlea duct. urticle -horizontal movement receives the semicircular ducts.

Question 32

Q

Submandibular Gland 1

i) Location
ii) (Once again) What is at risk during surgery
iii) relation of facial artery and vein to submandibular gland

Answer

A

i) Posterior inferior to horizontal mandibular ramus in digastric triangle.
ii) Marginal Mand. Nerve (Lip droop), Lingual Nerve,

Hypoglossal Nerve

iii) Artery- passes deep to the gland

vein - passes superficial to the gland

Question 33

Q

Submandiublar 2

1-12

Answer

A

1. Frontalis 2. Obicularis Oculi 3. Temporalis

4+5. Levator Labii Superioris 6. Orbicularis Oris

7. Levator Angular Oris 8. Zyg. Major

9. buccinator 10. Depressor anguli Oris

11. Depressor Labii Inferioris 12. masseter

Question 34

Q

Submandibualr 3

13-25

Answer

A

13. parotid gland 14. submandibular gland

15. Horizontal body of mandible

16. Facial Artery 17. Sup. Temp. Artery

18. Angular Vein 19. Facial Vein 20. IJV

21. Stenson’s (parotid) duct 22. Temporalis Fascia

23. Facial nerve (upper div.)

24. VII Buccal branches 25. VII Zyg. Branches

Question 35

Q

The Nose

1-12

Answer

A

1. Frontal Bone 2. Nasal Bone 3. Superior Concha

4. Sphenoid Sinus 5. Pituitary GLand

6. Middle Meatus 7. Hiatus Semilunaris

8. inferior Conchae 9. inferior meatus

10. nasopharynx 11. tubular ridge

12. opening of eustachian tube

Question 36

Q

The nose

13

Answer

A

13. Adenoid 14. Pharyngeal Recess

15. Salpingopharyngeal fold 16. Pharyngeal isthmus

17. Hard palate 18. Soft palate

19. oral cavity 20. oropharynx

21. palatopharyngeal fold 22. Palatoglossal fold

23. Intrinsic tongue muscles 24. Nares

Question 37

Q

The nose

1-20

Answer

A

1. inferior meatus 2. inferior conchae

3. Hard palate 4. soft palate 5. Pharyngeal isthmus

6. palatopharyngeal fold 7. palatoglossal fold

8. oral cavity 9. Fungiform papillae

10. Vallate papillae 11. oropharynx 12. lingual tonsils

13. intrinsic tongue muscles 14. Genioglossus

15. geniohyoid 16. epiglottis 17. piriform fossa

18 Vallecular 19. hyoid bone 20 laryngeal inlet

Question 38

Q

Broad divisions of oral/ nasal cavity:

1) Nasal Cavity
2) Nasopharynx
3) Oral cavity
4) Oropharynx
5) Laryngopharynx

Answer

A

1) Nares–> imaginary line through start of soft palate and base of skull
2) Ends at a line drawn between uvula (end of soft palate and base of skull)
3) Lips to level of anterior epiglottis
4) Anterior border - Line between uvula and anterior epiglottis

Superior - level of uvula

inferior - level of hyoid bone

5) hyoid bone to the level of trachea/oesophageal divergence

Question 39

Q

Oropharynx

1-13

Answer

A

1. Pituitary Gland 2. sphenoid Sinus

3. Middle Concha 4. Adenoids 5. Nasopharynx

6. Auditory Tube Opening 7. Pharyngeal recess

8. tubal ridge 9. salpingopharyngeal fold

10. Soft palate 11. Uvula/pharyngeal isthmus

12. palatoglossal fold 13. palatopharyngeal fold

Question 40

Q

Oropharynx

14-26

Answer

A

14. Oropharynx 15. Post. Pharyng. Wall

16. Lingual Tonsil 17. Epiglottis

18. Laryngopharynx 19. Hyoid Bone

20. Vestibular Fold (false cords) 21. Laryng. Sinus

22. Vocal Fold (true cord) 23. Trachea

24. Oesophagus 25. Retropharyngeal Space

26. Piriform fossa

Question 41

Q

Oropharynx

27-38

Answer

A

27. Anterior arch of atlas 28. Dens 29. C3 Body

30. Basilar ARt. 31. Vertebral art. 32. PICA

33. Pons 34. medulla oblongata 35. Cerebellum

36. 4th Ventricle 37. Cisterna Pontis

38. Central Canal

Question 42

Q

Anterior Neck Anatomy

1-14

Answer

A

1. Parotid Gland 2. Submandibular Gland

3. masseter 4. Platysma 5. Mylohyoid

6. Anterior Belly Digastric 7. Posterior belly digastric

8. Hyoid Bone 9. Omohyoid (Sup. Belly)

10. Sternohyoid 11.thryohyoid12. SCM

13. Clavicle 14. Deltoid

Question 43

Q

Anterior Neck Anatomy 2

15 - 30

Answer

A

15. Pec Major 16. Scal. Ant. 17. Scal. Med

18. Inf. belly Omohyoid 19. Levat. Scapul.

20. Semispinal. 21. Facial nerv. 22. Int. Jug Vein

23. Ansa Cervicalis 24. EJV

25. Carotid Sinus 26. ICA + ECA

27. Hypoglossal N. 28. Accessory N.

29. subscapular art. 30. Thyrohyoid Nerve.

Question 44

Q

What covers the roof + floor of the anterior neck triangle

Answer

A

Roof - Investing fascia

Floor- Visceral Fascia

Question 45

Q

Larynx

i) Cartilage types in the larynx

Answer

A

i) Epiglottis - Elastic

Thyroid, Cricoid, Aryetonoids, corniculate, cuneiform –> Hyaline

Question 46

Q

Larynx anatomy

1-9

Answer

A

1. Fungiform Papillae 2. Vallate Papillae

3. Foramen Caecum 4. Sulcus Terminalis

5. epiglottis 6. laryngeal inlet

*7.** valleculae 8. Posterior Pharyngeal Wall
*9.** Piriform Fossa

Question 47

Q

Larynx Anatomy 2

10-18

Answer

A

10. Arytenoid Cartilage / Fold

11. Laryngopharynx 12. Vestiublar Fold ( False Cord)

13. Vocal Fold (true cord) 14. Glottis

15. Cricoid Cartilage 16. Trachea 17. oesophagus

18. Lingual Tonsils

Question 48

Q

Posterior Triangle

1-13

Answer

A

1. parotid 2. Submandib. LNs

3. posterior belly of digastric 4. Submand. Gland

5. SCM 6. Splenius Capitis 7. Levator Scap.

8. trapezius 9. Scal. medius 10. Scal. Post.

11. ECA 12. Facial Art. 13. CCA

Question 49

Q

posterior triangle

Answer

A

14. Greater Auricular N. 15. Hypoglossal N.

16. Cervical Plex. 17. Transv. Cerv. N.

18. Brachial Plex (upper trunk)

19. Suprascapular N. 20. Phrenic n.

21. Supraclavicular N. 22. Lesser occipital n.

Question 50

Q

Accessory N.

i) Course
ii) Innervates
iii) Testing weakness

Answer

A

i) Exits skull vault through Jugular Foramen. Passess deep to SCM and stays near trapezius.
ii) innervates SCM + Trapezium
iii) Trapezius - Shrug

SCM - Resisted turning head (If left turn is weak then contralateral [right] CNXI is damaged)

Question 51

Q

Parotid Anatomy

Answer

A

1. Orbicularis Oculi 2. Zygomaticus Major

3. Zygomaticus Minor 4. Levator Angular Oris

5. Orbicularis Oris 6. Depressor ANgular Oris

7. Platysma

8. Masseter 9. SCM 10. Parotid Gland 11. parotid duct (stenson’s) 12. Accessory Parotid gland

13. Superficial Temporal Art. 14. Facial ARtery.

15. Facial Vein 16. Angular Vein

17. Facial N. Upper Div.

18. Temporal N. 19. Zygomatic N. 20. buccal N.

21. Marginal Mandib. N. 22. cervical n.

Question 52

Q

Clavicle

Label 1 - 6

What ataches 7-15

Name articulation 16-17

Answer

A

1. Acromial End 2. Ant. Border 3. post. border

4. conoid tubercle 5. shaft 6. sternal end

7. Trap. 8. Delt. 9. SCM 10. Pec Maj.

11. Subclavius 12. Interclavicular lig

13. Trapezoid portion of coroclavicular lig.

14. Conoid portion of coroclavicular lig.

15. Costoclavicular ligament

16. Sternum ARticulation

17. Acromion Articulation

Question 53

Q

Subclavian Art.

Define the three parts

Branches and where they arise

Branches of the Branches

Answer

A

i) Parts:

1 - origin to scalenus anterior (medial border)

2 - behind scalenus anterior

3 - from lateral borer of scalenus anterior to 1st rib

ii) Branches:

1st Part - Vertebral, Internal Thoracic, Thyrocervical

2nd Part - Costocervical, Dorsal Scapular

iii) B of Bs

Verebtral - Ant. + Post. Meningeal arteries, 1 x Ant spinal artery, 2 x Post Spinal ARtery, PICA (End as they converge to form basillar artery)

Internal Thoracic Artery - terminates as musculophrenic artery + superior epigastric artery

Thyrocervical Trunk - Inf. Thyroid Ard, Suprascapular art., Transverse cervical art., ascending cervical art.

Costocervical trunk - Terminates as deep cervical artery, sup. intercostal art.

Question 54

Q

Ribs

i) How do they articulate with sternum
ii) Where is the intercostal bundle?
iii) Which rib has 2 tubercles
iv) Describe relations to the scalene tubercle

Answer

A

i) 1-7 - Have individual costal cartilage

8-10 - Have shared costal cartilage

11-12 - have no costal cartilage

ii) intercostal bundle exists in a groove on the lower surface of the rib

iii) First rib - Scalene Tubercle and costal tubercle

iv) Ant. to the tubercle is the groove for the subclavian vein

Post. to the tbercle is the groove for subclav. art. + lower trunk of brachial plexus

Question 55

Q

Clavicle

Where do the major muscles attaching to the clavicle attach.

Answer

A

Superior Surface:

Acromial End

Trapezius (posterior)
Deltoid (anterior)

Sternal End

Sternocleidomastoid (posterior)
Pec Major (anterior)

Inferior Sruface:

Subclavius muscle

Question 56

Q

Intercostal

i) Muscles how many are there - name then

ii) Where is the intercostal bundle - name the structures from the top downwards

Answer

A

i) Three

External - Downwards and forwards (inhalation)

Internal - Downwards and backwards (exhalation)

Innermost - Transversus thoracicus (ant.), lateral slips (lat.), subcostalis (post.)

Fibers of internal and external intercostal muscles run in opposite directions.

ii) Run in a groove beneath rib in between the innermost and internal intercostal muscles

(Most Superior) Vein, Artery, Nerve

Question 57

Q

Label 1-12

Answer

A

1. Thoracic Aorta 2. Thoracic Duct

3. Ayzgous vein 4. Sympathetic trunk

5. Intercostal Vein, 6. Int. ARt. 7. Int Nerve

8. Sup. Intercostal Vein

9. Vertebral Body 10. Vertebral Disc

11. Rib 12. Innermost intercostal muscle

Question 58

Q

Label 1-19

Answer

A

1. Trachea 2. Inf. Thyroid Vein 3. Trachea

4. R. Main Bronch. 5. L. Main Bronch.

6. Subcarinal LNs 7. Oesophagus

8. Aortic Root 9. Brachiocephalic Trunk

10. Ext. Carotid Art. 11. Subclav. Art.

12. Internal Thoracic ARt. 13. Costocervical Trunk

14. Subclav Art. 15. Common Carotid Art.

16. R Vagus 17. L Vagus 18 R phrenic trunk

19 R Sympathetic trunk

Question 59

Q

Trachea

i) What level does it originate and divide?
ii) relations of trachea in neck
iii) What are the walls of the trachea made of?

Answer

A

i) Originates at C6 (lower border of cricoid cart.) and divides at T4 (carina is behind angle of louis)

ii)

ant. Thyroid, inf. thyr. vein, sternohyoid, sternothyroid

post. Oesophagus, RLN in oesophagatracheal groove

lat. carotid sheath, lateral thyr. lobes

iii)

Walls of trachea are made of:

C shaped cartilage anteriorly + laterally
Membranous wall posteriorly with trachealis muscle

Question 60

Q

Angle of Louis

i) What vertebral level
ii) What anatomical releavance

Answer

A

i) Level of T4/T5 Vertebrae
ii) Carina, Start+ End of aortic arch

Aygos drains into SVC,

THoracic Duct crosses R -> L behind oesophagus

Division of Sup/Inf Mediastinum

L RLN loops behind aortic arch

Question 61

Q

Label 1-12

Answer

A

R Lung

1. Upper Lobe. 2. Lower Lobe 3. Middle lobe

4. Apex 5. Base

6. Horizontal Fissure 7. Oblique Fissure

8. impresion of subcl. art.

9. impression of 1st rib

10. impression of azygous vein

11. Right Atrium 12. Pul Arteries

13. Bronchus 14. Pul Veins

Question 62

Q

Label 1-13

Answer

A

1. Upper Lobe 2. Lower Lobe

3. Apex 4. Lingula 5. Base

6. Oblique Fissure

7. Impression for 1st Rib

8. impression for Subclav. ARt

9. Impression for Aorta

10. Impression for L Ventricle

11. Pul. Art. 12. Bronchus 13. Pul Vein

Question 63

Q

Pulmonary Artery

i) Course of R Pul ARt.

ii) Course of L Pul Art

Answer

A

i) Arise from pulmonary trunk.

Passes in front of oesophagus

behind ascending aorta/ SVC

then at the root it passes between R Main Bronchus and Upper lobe bronchus

Divides into ther branches (lobar)

ii) Arises from PT. Connected to aortic arch by ligamentum arteriosium.

Passes in front of the descending aorta/ L Main Bronchus

Question 64

Q

i) Describe the pleural cavity

ii) Describe hiccough reflex

iii) Surface markings of pleura

iv) Surface markings of lung

Answer

A

i) Potential space in between visceral pleura (covering the lungs, vessels, bronchi + nerves) and the parietal pleura (attached to the chest wall - endothoracic fascia) .
ii) HIccough is caused by phrenic nerve (+its distribution) irritation leading to contractions of the daiphragm
iii) 2nd rib - are converged and then diverge again at the 4th rib. 6th rib parasternal 8th rib mid clavicular 10th rib mid axillary 12th rib converge

at erector spinae

iv) 6th rib mid clavicular line 8th rib mid axillary line 10th rib Erector Spinae

Answer 64

A

1. Upper Lobe 2. Midle lobe 3. lower lobe

4. Upper Lobe 5. Lower Lobe 6. Manubrium

7. Diphragm 8. R Lobe Liver 9. L Lobe Liver

10. Falciform Ligament

11. R Apex 12. R Horizontal Fissure 13. R Oblique Fissure 14. L Apex 15. L oblique fissure

16. Int. Thorac. Art. 17. Costal (parietal) Pleura

18. Mediastinal (parietal) pleura

19. Fibrous Pericardium (Superficial to parietal pleura)

20.

Answer 65

A

Visceral Pleura - Supplied by vagus nerve

Parietal Pleura - Supplied by intercostal nerves

Diaphragm - Phrenic nerve (C3-C5)

Parietal pleura and diaphragm both have pain receptors whereas the visceral pleura does not.

Answer 66

A

i) T8 Caval Foramen (Central tendon)

Contains - IVC + R Phrenic Nerve (L pierces diaphragm directly)

ii) T10 Oesophageal Foramen (R Crus)

Contains- Oesophagus, L Gastric A+V, Vagus trunks

iii) T12 Aortic Foramen (Behind diaphragm)

Contains - Abdominal Aorta, Thoracic Duct, Azygos Vein

iv) L Phrenic Nerve, Splanchnic nerves, Superior epigastric vessels, Sympahetic chain (Behind median arcuate ligament)

Embryologically diaphragm forms from fusion of -

Septum Transversum, Foregut Mesentery, Ingrowth from body wall, Pleuroperitoneal membrane

Septum Transversum forms Central Tendon

Foregut Mesentery forms oesophageal opening + crura

Answer 67

A

1. IVC 2. Oesophagus 3. Aorta

4. Renal Art. 5. Coeliac Art. 6. SMA

7. Pericardiophrenic Art. 8. Inf. Phrenic Art.

9. Costal Fibers of diphragm 10. R Crus

11. L Crus 12. Median Arcuate Lig.

13. Central Tendon 14. Sternal Diaphragm Fibers

15. L Renal Vein

Answer 68

A

Through Bochdalek Foramen - Left usually (through pleuroperitoneal membrane)

Through Morgagni foramen - Anterior through xiphoid and costal origin

Can also herniate through - large oesophageal foramen + through deficient central tendon

Answer 69

A

i) Imaginary line through the sternal angle seperates the superior (to the thoracic arpeture) and inferior (to the diaphragm) mediastinum.

Superior - Anteriorly - Manubrium to sternal Angle

Posterior - T1 - T4 Vertebrae

Anterior - Between sternal angle and diaphragm (anteriorly chest wall, posteriorly the pericardium)

Middle - Pericardium

Posterior - Anteriorly pericardium, Posteriorly vertebrae, superiorly sternal angle, inferiorly the diaphragm

Answer 70

A

i) Vessels- Arch of aorta + branches, SVC + tributaries( Azygos, brachiocephalic, supreme intercost., L Sup. intercostal)

Nerves - phrenic (ant. to ant. scalene), R Vagus (Post. to SVC and R main bronch.), L Vagus (Ant. to Aortic ARch and post. to L Main bronchus), Cardiac Nerves, Sympathetic Trunk

Muscles- Sternohyoid, Sternothyroid

Others- Thymus, Trachea, Oesophagus, Thoracic Duct

ii) Sternopericardial Ligaments (+thymus - mainly in children
iii) Vessels- Ascending Aorta, SVC, Pulmonary Trunk

Nerves - Cardiac plexus, Phrenic Nerves

Others - Heart, Tracheobronchial LNs, Primary Bronchi (+carina)

iv) Vessels - Descending aorta + branches (9 paired post. intercostal, 1-2 Paired bronchial arteries, 1-2 unpaired oesophageal arteries, Sup. phrenic arteries), Azygous System

Nerves - L+R Vagus Nerves ( form oesophageal plexus and then as leaving diaphragm converge to form L+R Vagal Trunks), Sympathetic Trunks

Others - Oesophagus (posterior to aortic arch / aorta), Thoracic Duct (Anterior to vertebral bodies),

Answer 71

A

In the posterior mediastinum:

Azygous vein - Formed from R Lumbar + R Subcostal veins. Enters with aorta through aortic hiatus.

Essentially drains the posterior lumbar and thoracic wall

Hemiazygous vein - Formed from L Lumbar L subcostal vein. Enters through L crus of diaphragm. At T8 crosses vertebrae and drains into ayzous vein.

Accessory Hemiazygous Vein - Formed from L 4th-8th intercostal veins. Crosses at T7 to drain into Azygous Vein.

The ayzgous vein empties into the SVC by passing over the R Main Bronchus at the root of the lung.

IVC obstruction - There is collateralisation through the azygous system to the SVC through:

Lumbar Azygous Veins (between renal veins and azygous veins) which form communication between IVC and azygous vein (at its origin)

Answer 72

A

i) 2 Pairs of pulmonary veins - 1 inferior + 1 superior

all draining into L Atrium

ii) SVC formed by unification of both brachicephalic veins. The SVC travels laterally to the right mediastinum and then pierces the middle mediastinum before emptying into the right atrium.
iii) Groove running circumferentially around the heart ‘seperating’ the atria from the ventricles
iv) Running vertically down the surface of the anterior + posterior aspcts of heart
v) Sinuses are formed from folds of the pericardium.

oblique sinus - on posterior surface of heart

trasnverse sinus - Posterior to the ascending aorta + pulmonary traunk / Anterior to the SVC. Seperates the main arteries/veins

Answer 73

A

i) Divided by the crista terminalis (muscular ridge) into the sinus venarum (posterior to CT) and the atrium proper (anterior to CT) which has pectinate muscles. Coronory Sinus also opens into the right atrium
ii) Fossa Ovalis is a remnant of the foramen ovale in between the R and L atriums on the interatrial

septum.

iii) Posterior border of the heart. Superiorly is the l auricle. Two portions of the L atrium (interior) - posterior is the inflow portion receiving blood from PVs and the anterior is the outflow portion which is lined by pectinate muscles.

Answer 74

A

i) Trabeculae Carnae - are a series of muscular elevation predominantly in inflow tracts. Different types are -

Papillary Muscles - are attached to the tricuspid/mitral valve by Chordae Tendinae. They contract to prevent valve prolapse during ventricular systole

Ridges + Bridges (Important example of a bridge is the moderator band of R Ventricle)

Supraventricular Crest - Divides inflow and outflow portion of the R Ventricle

ii) 3 - on right as tricupid has 3 leaflets

2 - on left as mitral has 2 leaflets

iii) Conus Arteriosus - is the outflow tract of the R Ventricle where as the L Vetnricle outflow tract is called the aortic vestibule. Both develop from the bulbus cordis.

Answer 75

A

i) Sinoatrial Node is in the wall of right atrium near the SVC
ii) PR interval is caused by delayed conduction in the atrioventricular node situated in the atrioventricular septum near the coronary sinus
iii) Immediately after the AV node is the bundle of his within the interventricular septum. This then branches into the Right and Left Bundle.

Right Bundle - Only 1 Fascilce

Left Bundle - Anterior and Posterior fasicle.

The bundles then continue to the apex of the heart from where purkinje fibers begin to extend into the subendocardium disseminating action potential to myocardium.

iv)

Right ventricle lead - practically all devices

Right atrial lead - dual chamber devices

Coronary Sinus lead - Biventricular devices

Answer 76

A

i) Fibrous Pericardium - Continuous with central tendon of diaphragm. Non distensible

Serous Pericardium - Seperated into -

Parietal Pericardium

Visceral Pericarium - Also known as the epicardium

ii) Innervated by the phrenic nerve

Answer 77

A

i) Aortic Sinuses are behind the aortic valve leaflets and blood enters this in diastole.

Aortic Sinuses go on to form the:

Left Coronary Artery + Right Coronary Artery

Left coronary artery gives three branches(or four):

Left Anterior Descending (Anterior Inteventricular groove. AKA Anterior Interventricular Artery)

Left Circumflex ARtery (In the coronary sulcus. Gives rise to the L Marginal Artery)

(rarely the posterior interventricular artery)

Right Coronary artery (runs in the coronary sulcus) gives two branches (or one):

Right Marginal Artery

Posterior Interventricular Artery (Post. IV Groove)

ii) Veins eventually drain into the coronary sinus (located posteriorly on the coronary sulcus which in turn drains into the R atrium )

Anterior Veins are the :

Great Cardiac Vein - In anterior interventricular groove

Small Cardiac Vein - Right Sided

Posterior vein is the :

Middle Cardiac Vein

Left Marginal Vein

Left posterior ventricular vein

Answer 78

A

1. Iliac Crest 2. Iliac Tubercle 3. ASIS

4. Gluteal Fossa 5. Body of Ilium

6. Lunate surface 7. Acetabular Fossa

8. Acetabular Notch 9. Ischial Tuberosity

10. Ischial Body 11. ischial spine

12. AIIS 13. Iliac Fossa 14. Iliac Tuberosity15. PSIS 16. PIIS

Answer 79

A

Arcuate Line

18. Iliopubic eminence 19. Pubic tubercle

20. pubic crest 21. pubic symphysis

22. Inf. Pub. Ramus 23. Ischial Ramus

24. Obturator Crest 25. Lesser Sciat. Notch

26. Greater Sciat. Notch

27. Groove for obturator Externus

28. Post. Gluteal Line 29. Inf. Gluteal Line

30. Ant. Gluteal Line 31. Obturator foramen

32. Obturator groove

Answer 80

A

i) Anterolateral - Greater Sciatic Notch of ilium

Posteromedial - Sacrotuberous ligament

Inferior- Sacrospinous lig and ischial spine

Superior - Ant. Sacroiliac ligament

ii) Piriformis runs through and ‘divides the GSF’

Total - 7 nerves, 3 Vascular Sets + Piriformis

Above Piriformis

Superior Gluteal Vessels + Nerve

Below Piriformis

Vascular - a) Inf Gluteal Vessels b) Int. Pudendal vessels

Nerves - a) Sciatic Nerve b) Inf. Glut. Nerve

c) Pudendal Nerve d)Post. Fem. Cutaneous Nerve
e) Nerve to obturator Internus
f) Nerve to quadratus femoris

Answer 81

A

i) Principally three arteries:

Medial Circumflex Femoral Artery (largely)

Lateral Circumflex Femoral Artery

Artery to head of femur (branch of obturator artery with minor contribution)

Medial and lat circ branch of profunda femoris artery

ii) Has both ant. and post. femoral attachment

Ant. - Intertrochanteric Line

Post. - More proximal on femoral neck

iii) Iliofemoral Ligament -AIIS ->Intertrochanteric line

Pubofemoral Ligament - Superior pubic rami -> Intertrochanteric Line (triangular shape)

Ischiofemoral Ligament - Body of ischium -> Greater trochanter (Spirals)

Answer 82

A

Attachment for:

1. Gluteus Minimus 2. Piriformis 3. gluteus medius

4. Quadratus Femoris 5. Iliopsoas 6. Glut. Max.

7. Vastus Lateralis 8. Vastus Medialis

9. Obtur. Internus + Gemellae

10. Iliofemoral lig. 11. Lig. Teres

Answer 83

A

i) Iliopsoas, Pectineus, Sartorius, Rectus Femoris
ii) Superior to Inferior. Piriformis, Sup. Gemelli, Obt. int. + Ext., Quadr. Fem.
iii) TFL, Glut. Med + Min

Answer 84

A

Origin - Iliac Fossa, T12 - L5 vertebrae

Insertion - lesser trochanter

Innervation - Femoral Nere (+L1-L2)

Answer 85

A

Innervated - Superior Gluteal Nerve (L4-S1 Sacral Plexus)

Glut Med + Min -> Glut Fossa of Ilium -> Greater trochanter

TFL -> Iliac Crest -> IT Band

Answer 86

A

1. Glut. Max. 2. Glut Med. 3. Glut. Min.

4. Piriformis 5. External Obliq. 6. Obt. Extern

7. Obt. Int./ Gemellae 8. Levator Ani

9. Hamstring Origin 10. Iliac Crest

11. Gluteal Fascia 12. Lumbar Fascia

13. Sacrotuberous ligament

14. Ischial Tuberosity 15. Greater Trochanter

16. Hip Joint Capsule 17. Sup. Glut. Art.

18. Sup. Glut. Nerve. 19. Inf. Glut. Nerve

20. Inf. Glut. ARt. 21. Post. Cut. Nerve of thigh

22. Sciatic Nerve (L4-S3) 23. Inf. Rect. Nerve

24. Cutaneous branches of lumbar dorsal rami

Answer 87

A

i) L4-S3

ii) Ventral Rami L4-S3. Leave pelvis through GSF below piriformis. Travels beneath glut max traversing inferiorly between the greater trochanter and ischial tuberosity.

Travels superficially to adductor magnus before enterring poplital fossa.

iii)

Hamstring Muscles

Adductor Magnus (tibial portion)

External Rotators (Gemellae, Obt. Internus, Quad. Femor.)

Then –>

Common Peroneal Nerve : Ant. + Peroneal comparments

Tibial nerve: Deep and Superficial Posterior Compartments

sensation to posterior thigh and lateral leg

Answer 88

A

1. Med. Fem. Condyle 2. lat. Fem. Condyle

3. Fibular Head 4. Med. Meniscus 5. Lat. Meniscus

6. Post. Meniscofem. Lig 7. Post. Cruc. Lig

8. popliteus 9. Lat. Collateral Lig.

10. Prox. Tibiofibular Joint 11. Femur 12. Patella

13. Tibia 14. Fat Pad 15. Quadriceps Tendon

16. patella tendon 17. Suprapatellar bursa

Answer 89

A

1. Lat. Fem. Condyle 2. patella 3. Tib. Tuberosity

4. Quad. Tendon 5. Patel. Tendon

6. Lat. Meniscus 7. Lat. Colat. Lig

8. Bicep Femoris (Reflected inferiorly)

9. Popliteus 10. Lat. Head of gastroc. + plantaris

11. Tibial Nerve 12. Common Peroneal Nerve

13. Med. Fem. Conyle 14. Vastus Medial.

15. Hamstring tendon portion of add. magnus

16. Adductor Tubercle 17. Gracilis 18. Sartorius

19. Semitendinosis 20. Pes Anserina

21. Medial Gastrocnemius 22. Tibia

23. Med. Collat. Lig. 24. Adductor Hiatus

Answer 90

A

1. Patella Groove 2. Sup. Lat. Fem. Condyle

3. Sup. Med. Fem. Condyle 4. Med. Fem. Condyle

5. Lat. Fem. Condyle 6. Med. Tib. Condyle

7. Lat. Tib. Condyle 8. intercondylar eminence

9. Tib. Spine 10. Intercondylar Notch

11. ACL 12. PCL 13. Lat. Meniscus 14. Med. Meniscus

Answer 91

A

i) ACL - Lat. Condyle of femur -> Anterior intercondylar area

ii) PCL - Med. Condyle of femur -> Post. intercondylar area

iii) MCL - medial epicondyle of femur -> med tibial condyle

Part of the MCL directly communicates with the medial meniscus

iv) LCL - lateral epicondyle of femur -> fibular head

seperate from lateral meniscus

v) Common peroneal nerve - roughly 15%

Popliteal Artery - roughly 10%

Answer 92

A

i) Superior

Lateral - Bicep Fem

Medial - Semi memb/tend

Inferior

Med/Lat - Gastrocnemius

Roof - Fascia Lata

Floor - Post knee joint capsule + poplitues musc.

ii) Contents: (superficial to deep)

Nerves (most superficial) - Common peroneal nerve - Medial to bicep fem tendon.

Tibial Nerve - Crosses from lat. side of vessels to medial

Post. Cutaneous nerve of thigh - Medial

Pop. Vein (+lesser saphenous) then Pop. Artery

iii) Popliteal LNs drain the venous distrubiton of SSV

Answer 93

A

1. Semimembranosis 2. Biceps Fem

3. Semitendinosis 4. adductor magnus

5. plantaris 6. med. Gastroc. head

7. lat. gastroc. head 8. IT Band 9. Adductor Hiatus

10. Pop. Vein 11. Pop. Art. 12. Tib. Nerve

13. Common Peroneal Nerve

14. Med. Head Gastroc. Nerve 15. Sural Nerve

16. Sup. Lat. Genicular Artery

17. inf. lat. Genicular art.

Answer 94

A

Femoral artery - Continuation of external iliac artery becoming the femoral artery as it passes beneath the inguinal ligament to enter the femoral triangle. Beyond the femoral triangle it descends in the adductor canal.

Profunda femoris artery is a posterolateral branch of the femoral artery. In turn it gives off 3 main branches - Med and lat fem circumflex arteries and then some perforating muscular branches.

Obturator artery - arises from internal iliac artery and enters medial thigh through the obturator foramen. Supplies medial thigh compartment / deep gluteal muscles

Popliteal artery (discussed further below) - gives off 3 medial and 2 lateral genicular arteries

Lower Leg

Superficial femoral artery becomes Popliteal artery as it exits the adductor hiatus and enters popliteal fossa.

Just inferior to the popliteal fossa it bifurcates:

Anterior Tibial Artery - Becomes the dorsalis pedis artery in the foot (passes anteriorly beneath extensor retinaculum)

Tibioperoneal trunk -which then birfucates into the: posterior tibial artery passing posterior to medial malleolus

peroneal artery

Answer 95

A

1. med. tib. condyle 2. lat. tib. condyle

3. tib. tuberosity 4. Med. surf. tibia

5. fibular neck 6. fib head 7. Tibial Spines

8. Popliteal surface of tibia 9. Soleal line

10. Semimembranosis 11. patella tendon

12. Bicep Fem. 13. Soleus 14. Popliteus

15. Semitendin. 16. Gracil. 17. Sartorius

18. Pes Anserina 19. Med. Colat. Lig

20. Lat. Colat. Lig 21. IT Band

Answer 96

A

i) Anterior Compartment

Deep peroneal nerve/ Anterior Tibial Artery

Anterior Tibialis, Extensor Hallucis Longus, Extensor Digitorum Longus, Peroneus Tertius

ii) Peroneal Compartment

Superficial peroneal nerve/ Peroneal Artery

Peroneus Longs, Peroneus Brevis

iii) Superficial Posterior Compartment

Tibial Nerve/ Posterior TIbial Artery

Gastrocnemius, Soleus, Plantaris

iv) Deep Posterior Compartment

Tibial nerve/ Posterior Tibial Artery

Tibialis Posterior, Popliteus, Flexor hallucis longus, flexor digitorum longus

Answer 97

A

1. Lateral Malleolus 2. Medial malleolus

3. Tibialis Ant. 4. Extensor Hallucis Longus

5. Extensor Digitorum Longus

6. Extensor Digitorum Brevis

Answer 98

A

Posterior to med. malleolus:

Ant. -> Post (Tom, Dick + Very Nervous Harry)

Tib. Post

Flexor Digitorum Longus

Post. Tibial Art.

Post. Tibial Vein

Tibial Nerve

Flexor Hallucis Longus Tend.

Anterior to medial malleolus :

Long saphenous vein

Answer 99

A

1. Med. Malleolus 2. lat. malleolus 3. Tib. Anterior

4. Extensor hallucis longus 5. Extensor Dig. Long.

6. Extensor Dig. Brev. 7. Peroneus Brev.

8. Peroneus Tertius. 9. Extens. Halluc. Brevis.

Answer 100

A

1. Calcaneus 2. Talar Dome

3. Talar Neck 4. talar head 5. Navicular

6. Cuboid 7. Lateral Cuneiform

8. Intermediate Cuneiform 9. Medial Cuneiform

10. 1st Metatarsal 11. 3rd Metatarsal

12. 5th Metatarsal 13. Distal Phalanx 14. Proximal Phalanx 15. Distal phalanx 16. Middle Phalanx

17. Proximal phalanx 18. 1st metatrsal head

19. 1st metatarsal shaft 20. 1st metatarsal base

21. Ant. Tuberc. Calcaneus 22. Substentaculum Tali

23. Lateral process of calcaneus

24. Medial Tubercle of Talus

25. Lateral Tubercle of Talus

Answer 101

A

26. Jone’s Fracture - diaphyseal 5th metatarsal

27 + 28. Flexor Hallucis Longus

29. Peroneus Longus

Answer 102

A

i) Forefoot - MTs + Phalanges

Midfoot - Cuboid, Navicular + Cuneiform Bones

Hindfoot - Talus + Calcaneus ( True anle joint is between talus and tib/fib. Subtalar Joint between talus + Calcaneus)

Answer 103

A

1. Medial Malleolus 2. Calcaenus 3. lateral malleolus

4. Navicular 5. Medial Cuneiform

6. 1st metatarsal 7. talar dome

8. Cuboid 9. 5th metatarsal

10. Achilles Tendon (common tendinous insertion of gastrocnemius, plantaris + soleus)

11. Deltoid ligament 12. Posterior talo-fibular ligm.

13. Calcaneofibular ligament 14. Anterior talo-fibular ligament. 15. Long Plant. Ligament

16. Peroneus Brevis

Answer 104

A

Peroneus Brevis - (From fibula) to 5th metatrsal (alongside peroneus tertius)

Peroneus Longus - (More proximally on fibula) to 1st metatarsal

Answer 105

A

Medially: Deltoid ligament

This spans from the medial malleolus (tibia) to

i) substentaculum tali ii) calcaneonavicular lig.
iii) navicular tuberosity iv) medial talus

Laterally: Three Ligaments

Anterior Talofibular Ligament (Lateral Mal. of fib to ant. talus)

Posterior Talofibular Ligament (Lateral Mal. of fib to

post. talus)

Calcaneofibular ligament (Lateral Mal. to Lat. Calcan.)

Syndesmotic:

Anterior + Posterior Inferior Tibiofibular ligaments

Answer 106

A

125 degrees

Answer 107

A

The patella is a sesamoid bone

Answer 108

A

A. Vastus Medialis

B- Sartorius

C- Gracilis

D - Medial Gastroc

E/F - Semintendinosis

G - Rectus Femoris

H - Adductor Magnus (Hamstring Portion)

Answer 109

A

Anterior Cruciate Ligament - Anterior tibia to lateral intercondylar notch of femur

Posterior Cruciate Ligament - Posterior tibita to medial intercondylar notch of femur

Answer 110

A

1. Humerus Head 2. Anatomical Neck

3. Surgical Neck 4. Greater Tub.

5. lesser tub. 6. Bicipital groove

7. Capitulum (radius head) 8. Trochlea (Ulna trochlea fossa) 9. Coronoid Fossa

10. Medial Epicondyle 11. Lateral Epicondyle

12. Olecranon fossa

Answer 111

A

Supraspinatous - Supraspinatous fossa - Sup. fac. Greater tuberosity. abducts

Suprascapular Nerve

Infraspinatous - Infraspinatous Fossa - Med. Fac. greater tuberosity. external rotate

Suprascapular nerve

Teres Minor - Lateral border of scapula - Inf. Fac. Greater tuberosity
Axillary Nerve. external rotate

Subscapularis - Subscapular fossa - Lesser Tuberosity

Upper + Lower Subscapular nerves. internal rotate

Answer 112

A

Coracoid Process: Three Muscles

Short head of biceps*
Corachobrachialis*
Pectoralis minor*

Interubercular Groove: Three Muscles

Latissimus Dorsi*
Pectoralis Major*
Teres Major*

Greater Tubercle: Three Muscles

Supraspinatous*
Infraspinatous*
Teres Minor*

Lesser Tubercle: One Muscle

Subscapularis

Answer 113

A

Biceps - Musculocutaneous nerve (Lat. Cord- C5-C6)

Short head: Coracoid Process

Long Head: supra-glenoid tubercle

both insert onto the bicipital tuberosity (radius)

Long Head is situated more laterally mid -humeral shaft. Generall the long head is the more bulky of the two.

Answer 114

A

1. Subscapularis 2. Supraspinatous

3. Long Head Biceps 4. Short head biceps

5. Coracoid Process

Muscles - Corachobrachialis, short head biceps, pectoralis minor

Ligaments - Corachoclavicular, corachoacromiial, coracohumeral lig., superior transverse scapular lig.

Answer 115

A

1. Supraspinatous 2. Subscapularis

3. Lat. Dorsi 4. Pec. Major 5. Teres Major

6. Coracobrachialis 7. Brachialis

8. Brachioradialis 9. Extensor carp. radi. long.

10. Radial groove (radial nerve)

11. Infraspinatus 12. Teres Minor

13. Triceps (Lat.) 14. Triceps (Med.)

15. Anconeus 16. Supracondylar

17. Medial epicondyle (humerus) - Ulnar nerve

Answer 116

A

Originates from posterior cord of brachial plexus.

Exits the axilla - through triangular space (Lat - Humerus, Med - Long head triceps, Sup - Teres Major)

Before the elbow it innervates:

Triceps, Brachioradialis, anconeus, Extensor carpi radialis longus

+ 3 sensory branches (posterior cutaneous nerve of arm, forearm + lateral cutaneous nerve of arm)

Then

Travels along the radial groove posteriorly before piercing intermuscular septum to enter cubital fossa at lateral epicondyle dividing into the:

superficial radial nerve (sensory) - runs lateral to radial art. under brachioradialis into the anatomical snuffbox supplying the hand

posterior interosseus nerve (motor) - pierces supinator distal to the radial head and runs in the extensor compartment supplying supinator + extensors

Answer 117

A

1. CCA 2. SCA 3. Axillary art.

4. Brachial Art. 5. Subclavian Vein 6. Axillary Vein

7. lat. cord 8. post. cord 9. med. cord.

10. Thoracoacromial trunk 11. Lat. Thorac. art.

12. Axil. Nerv 13. Musculocut. nerve

14. Radial nerve. 15. Median Nerve

16.Median Nerve 17. Ulnar nerve + medial cut. nerve of forearm

18. Thoracodorsal nerve 19. Long thoracic Nerve

20. Cephalic vein 21. External Jug. Vein

Answer 118

A

i) Boundaries:

Med- Pronator Teres

Lat. - Brachioradialis

Sup. - line between epicondyles

ii) Contents:

Median Nerve (just medial to brachial art.)

Brachial Art.

Biceps Brachii Tendon

Deep branch of radial nerve ( becomes post. interos. n.)

Answer 119

A

1. Biceps Tendon 2. Brachial Art. 3. Med. Nerve

4. Basilic Vein 5. (medial epicondyle side)

6. (lateral epicondyle side) 7. Median. Cub. Vein

8. Cephalic Vein 9. Rad. Recurrent Vein

10. Med. Cut. Nerve of forearm

11. Ulnar nerve 12. radial nerve 13. Sup. Rad. Nerve

14. Deep Rad. Nerve 15. Post. Interosseus Nerve

16. Lat. Cut. Nerve of forearm 17. Brachioradialis

18. Biceps 19. Pronator Teres

20. Bicipital Aponeurosis

Answer 120

A

1. Humerus 2. Lateral Epicondyle

3. Medial epicondyle 4. Radial Fossa

5. Coronoid Fossa 6. Capitulum 7. Trochela

8. Coronoid Process 9. Radial Neck 10. Radial Head

11. Olecranon 12. Radial Tuberosity

13. Radial Collateral Ligament

14. Ulna Collateral Ligament 15. Annular Ligament

16. Supinator Fossa 17. Lateral Supracondylar Ridge

18. Medial supracondylar ridge

Answer 121

A

1. Brachialis 2. Brachioradialis

3. Extensor Carpi Radialis Longus 4. Pronator Teres

5. Brachialis 6. Flexor Digitorum 7. Pronator Teres

8. Supinator 9. Flexor Digitorum Profundus

10. Biceps 11. Triceps

Answer 122

A

1. Bicep Tendon 2. Brachial art. 3. Median Nerve

4. Median Cubitan Vein 5. Cephalic Vein

6. Bicipital aponeurosis 7. Ulnar Art.

8. Recurrent Radial Art. 9. Ant. Interosseus Nerve.

10. Common Interosseus Art. 11. Radial ARt.

12. Superficial Palmar Art. (Radial Art.) 13. Ulnar art.

14. Superficial rad. nerve ( Dorsum of hand + anatomical snuffbox) 15. Brachioradialis

16. Pronator Teres 17. Flexor Carpi Radialis

18. Flex. Dig. Profondus 19. Palmaris longus

20. Flexor Carpi Ulnaris

Answer 123

A

1. Brachioradialis 2. Extensor carpi radialis long.

3. Extensor carpi radialis brev. 4. Extensor digitorum

5. Ulna Head 6. Extensor Carpi Ulnaris

7. Extensor digiti minimi 8. Abductor pollic. long

9. Extensor pollic. long. 10. Extensor pollic. brev.

11. Extensor carpi radialis longus

12. Extensor carpi radialis brevis

Answer 124

A

1. Extensor digitorum 2. Extensor digiti minimi

3. Extensor carpi ulnaris 4. extensor pollicis longus

5. extensor carpi radialis brevis

6. Abductor Pollicis longus

7/8. Extensor Pollicis Brevis 9. Extensor pollicis Longus 10. Extensor indices 11. Extensor Retinaculum

12. Radial head 13, Interossues Membrane 14. Anterior Interosseus Artery

15. Radial nerve

Answer 125

A

1. Biceps Tendon 2. Brachial Art. 3. Median Nerve

4. Median cubital vein 5. Bicipital Aponeurosis

6. Radial Nerve 7 + 8. Cephalic Vein

9. Radial Artery 10. Ulnar ARtery 11. Ulnar nerve

12. Anterior interosseus nerve (median nerve)

13. Anterior interosseus artery 14. Ulnar artery

15. Brachoradialis 16. Pronator Teres

17. Flexor Carpi Radialis 18. Flexor Carpi Ulnaris

19. Palmaris Longus 20. Pronator Quadratus

21. Flexor Digitorum Superficialis Tendon

22. Palmaris Longus Tendon

Answer 126

A

Pronator Teres

Flexor Carpi Radialis

Palmaris Longus

Flexor Digitorum Superficialis

Flexor Carpi Ulnaris

Answer 127

A

These arise form the volar surface of ulna +radius:

Flexor Pollicis Longus

Flexor Digitorum Profundus

Pronator Quadratus

ALL of the flexors are supplied by the Median Nerve

Except

Ulnar half of Flexor Digitorum Profundus + Flexor Carpi Ulnaris - Ulnar Nerve

Answer 128

A

Bifurcates at antecubital fossa into :

i) Radial Artery - Continues laterally and anteriorly. Winds laterally around the wrist passing through the anatomical snuffbox.

ii) Ulnar ARtery - Runs deep at its origin on top of brachialis and flexor digitorum profundus. Relationship to medial nerve is important as it begins medially before crossing it to run laterally. Enters the wrist underneath transverse carpal ligament on radial side of psiform bone within guyon’s canal

Answer 129

A

1. Radial Styloid 2. Lister’s Tubercle

3. Surface for scaphoid 4. Surface for lunate

5. Ulnar styloid 6. Hook of hamate 7. Pisiform

8. Trapezum Ride 9. Scaphoid Tubercle

10. Flexor Retinaculum 11. APB Tendon

12. EPB Tendon 13. ECRL Tendon 14. ECRB Tendon

15. EPL Tendon 16. ED Tendon 17. EI Tendon

18. EDM Tendon 19. ECU Tendon

20. Triangular Fibrocartilage

Answer 130

A

Look - Thenar wasting, ulnar deviation

Sensation - Thenar eminence (superficial median nerve) Volar aspect of index finger (median nerve)

motor -

Okay sign - FPL/FDP

Palms on table and abduct thumb - APB

Hold the middle phalanx and flex finger tip - FDP

Hold all other fingers in extension and ask them to flex one - FDS

Pronate in elbow extension - Pronator Teres

Special Tests:

Do a button - FDP/FPL

Tinel’s Sign - Tap

Phalen’s sign - flex for 60 seconds

Compression test - symptoms

Answer 131

A

Hand: Lateral Lumbricals, Opponens Pollicis

Abductor pollicis Bevis, Flexor Pollicis Brevis

Forearm:

Median Nerve Proper: Flexor Carpi Radialis, Flexor digitorum superficialis + palmaris longus

Anterior interosseus branch: FPL, Pronator Quadratus, Radial half of flexor digitorum profundus

Nerve Roots:

C6-T1

Course:

Originates from Lateral and Medial Cord.

Travels lateral to brachial artery in upper arm and then crosses to the medial side in the antecubital fossa.

Leaves the antecubital fossa between two heads of pronator teres giving off the

Anterior interosseus nerve (runs on the AIM between the FPL and FDL)

median nerve proper (continues more superficially to pass beneath the flexor retinaculum giving off palmar cutaneous muscle prior to passing through the carpal tunnel)

Answer 132

A

L1 - SMA + Neck of pancreas

Answer 133

A

Anterior:

T12 - Coeliac Axis (L gastric, Common Hepatic, Splenic)

L1 - SMA (Inf. Pancreatoduodenal, Jej + Ileal, Ileocolic, Right Colic, Middle Colic)

L3 - IMA ( Left Colic, Sigmoid, Sup. Rectal)

Posteriolateral:

T12- Inferior Phrenic

L1 - Suprarenal

L1-L2 - Renal Arteries

L2 - Gonadal Arteries

L1-L4 Four paired Lumbar arteries

Answer 134

A

Midline - Post(Ant).

L1 vertebra, Aorta, SMA, Neck of Pancreas, SMV , Pylorus

Lateral - Kidney hila, renal veins, Spleen hilum, Duodenum 2nd part, Portal vein formation (SMV + Splenic Vein meet), DJ Fexure, GB fundus, 9th costal cartilage

Answer 135

A

Communication between the greater and lesser sac of the peritoneal cavity.

Lesser Sac- Posterior to stomach medially/ posterior to greater sac laterally

Ant - Hepatoduodenal ligament of the lesser omentum (CBD, Common Hepatic Artery, Hepatic Portal Vein)

Post - IVC

Sup - Caudate lobe liver

Inf - 1st part duodenum

Answer 136

A

Functions: FISH

Filtration of encapsulated organisms

Immunological function

Storage of platelets

haematopoeisis in fetus

Potential to be damaged:

L Kidney, Splenic flexure, Stomach, Tail of pancreas, diaphragm

Ligaments

Gastrosplenic Ligament (greater curvature) - contain short gastric and left gastroepiploeic vessels

Lienorenal Ligament (attaches to the left kidney) - contains splenic vessels and tail of pancreas

Answer 137

A

i) Reconnection of the portal venous system with the systemic venous system.

ii) Oesphageal - Left Gastric/ Portal –> Azygous (system)

Rectal - Sup Rectal vein (port.) –> Mid/Inf Rect Veins (system)

Retroperitoneal

Umbilical

Hepatic (bare area)

Answer 138

A

12th rib posteriorly - Superior Renal Pole

Retroperitoneal parts of duodenum - 2nd, 3rd and 4th

Intraperitoneal Organs - Stomach, 1st part of duodenum, Colon (caecum, transverse, sigmoid), Tail of pancreas, Liver, Uterus and ovaries

Answer 139

A

Jejunum is (compared with ileum) -

Larger

Thicker

More Vascular

Darker Red

Longer vasa recta

Fewer arcades

Answer 140

A

i) Radiologically -

Haustrae (large bowel - traverse 1/3 width) and Valvulae Conniventes (Small bowl - entire width)

Small bowel is more central

Large bowel is more circumferential

ii) In addition - operatively:

Large bowel has appendices epiploicae and taenia coli

Answer 141

A

i) Parts: Head, Neck, Uncinate, Body, Tail

ii) Function:

Endocrine - Glucagon (alpha cells), Insulin (beta cells), Somatostatin (Delta Cells)

Exocrine - Lipases, Amylase

iii) Blood Supply:

Superior Pancretoduodenal Artery (gastroduodenal)

Inferior Pancreatoduodenal Artery (SMA)

Splenic Artery Branches

Answer 142

A

Lesser Curve - Right and Left Gastric Arteries

Greater Curve - Left (Splenic Art.) and Right Gastroeipoloic Arteries (Gastroduodenal Art.)- both also supply the greater omentum

Answer 143

A

i)

Pelvis - L1

Between T12-L3 vertebrae

ii) Relations:

Both:

Sup - Diaphragm,

Inf - Quadratus Lumborum

Lat - Transversus Abdominus

Med- Psoas major

Left Ant - Adrenal, spleen, stomach, tail of panc, small intest., colon

Right Ant- Adrenal, liver, colon, duodenum, small intestine

ii) Adrenal Layers:

Cortical Layers

Glomerulosa - Mineralocorticoid

Fasciculata - Glucocorticoid

Reticularis - Sex Hormone

Medulla - Catecholomines

Answer 144

A

Peroneus longus - head of fibula -> Medial cuneiform and base of 1st metatarsal

Peroneus Brevis - lower 2/3 of lat fib -> base of 5th metatarsal

peroneus tertius - lower 1/3rd fib and IO membrane -> base of 5th metatarsal

Answer 145

A

S1- Lateral foot

L4 - Medial malleolus

Deep Peroneal Nerve - First web space

Superficial peroneal Nerve - Dorsum of foot (not first web space)

Sural nerve - Lateral malleolus

Tibial nerve - Posterior Sole of foot

Saphenous nerve - Medial Aspect of foot

Answer 146

A

i) Anterior Tibial Artery and Vein

Deep Peroneal Nerve

ii) AT, EHL, EDL, PT

iii) Gastroc, Soleus, Plantaris (Superficial)

FHL, FDL, Pop, TP

iv) Foot inversion

v) Foot eversion / Dorsiflexion

vi) Flexion extension through - Talar-fibula/tibia joint

vi) inversion/eversion through - Subtalar joint

Answer 147

A

i) True ankle - synovial joint between tib/fib + talus

ii) Subtalar joint - Between the talus and calcaneous

Answer 148

A

Gluteal tuberosity (Gluteus maximus attachment)

Answer 149

A

Anterior Tibialis - Lateral tibial condyle –> Medial cuneiform and first metatrsal (dorsiflex/invert)

Extensor Hallucis Longus - Anterior fib/ IO membrane–> Distal phalanx of hallux (dorsiflex foot/hallucis + invert foot)

Anterior Compartment - ATA, ATV, Deep peroneal n.

Lateral Compartment - Superficial peroneal nerve

Deep posterior compartment - PTA, PTV, Tibial Nerve, Peroneal Artery

Answer 150

A

Attaching to the medial cuneiform - PL, TA, TP

Answer 151

A

Medial leg - Saphenous

Dorsum of foot - Superficial peroneal Nerve

First web space - Deep peroneal nerve

Answer 152

A

Pop Art. –> Divides into AT and TP Trunk

AT travels along the IO membrane in the anterior compartment becoming the DPA when it crosses between med/lat malleoli

TP Trunk divides 2.5cm after the initial bifurcation into the PTA and the PA.

PTA - in posterior compartment runs behind medial malleolus

PA - in posterior compartment between Tib. Post + FHL

Answer 153

A

i) Originates from dorsal venous arch of foot

Passes anterior to medial malleolus

Posterior to medial epicondyle of femur

Enters the femoral triangle and joins the femoral vein at the SFJ

ii) Originates from doral venous arch of foot.

Posterior to lateral malleolus

Runs posteriorly with the sural nerve.

Joins popliteal vein in popliteal fossa

Answer 154

A

From the epididymis through the inguinal canal to

Pelvic side wall to

Ejaculatory Ducts

It functions to transport sperm from the testes to the urethra

Answer 155

A

Seminal Vesicle

Outpouching of the vas deferens ampulla responsible for producing a fair volume of seminal fluid

Answer 156

A

i) Ureter enters bladder obliquely
ii) Relations:

Ant - Pubic Symphysis

Post - Recto-vesic pouch/denonvillier’s Fascia/ Rectum/ prostate - Male, Vesico-uterine pouch/Vagina - Female

iii) Pouch of douglas - Rectouterine pouch
iv) Arterial Supply - (Internal Iliac artery via:)

Sup. Vesicular Art

Mid. Vesicular Art

Inf. Vesicular Art.

(Prostatovesical in men) Vesical Venous Plexus –> Internal Iliac veins

v) Detrussor muscle is arranged into :

Longitudinal, circular + spiral bundles

vi) Innervation:

PNS (encourages micturition) - Pelvic Splanchnic Nerves + Inf. Hypogastric Plexus (S2-S4)

SNS (prevents micturition) - Hypogastric plexus

Pudendal Nerve (s2-s4) - External Urethral Sphincter

Answer 157

A

i) Divided into 3:

Upper 1/3rd - Renal art., Aortic branches, Gonadal Branches

Middle 1/3rd - Common iliac, Gonadal

Lower 1/3rd - Common Iliac/ Internal Iliac (Partic. Superior vesicular artery +uterine art.)

ii) Significance - Stones most often get stuck here

VUJ, As they traverse the pelvic rim, PUJ

iii) Upper + middle - T11- L2

Distal - Genitofemoral + Ilioinguinal nerves

Answer 158

A

Roots- Between anterior and middle scalene

Trunks - Base of posterior neck triangle

Divisions - Posterior to middle third clavicle

Cords - Surround the 2nd part axillary artery

Branches - Around the 3rd part axillary artery

Answer 159

A

i) Roots - C5-7

ii )Serratus Anterior

iii) C8
iv) T1
v) C6-8 from posterior cord (Latissimus Dorsi)
vi) C8-T1 from medial cord (Pec Maj + Min)
vii) C5 - C7 from lateral cord (Pec Maj )

Answer 160

A

KP

i) Abduction / tractional injury
ii) Lower roots effected so :

Intrinsic handle muscles are dennervated

Unopposed action of flexors/extensors of forearm ->

Claw hand (flexed IP joints , extended MCP joints)

EP

iii) Donward force from humeral head / shoulder.
iv) Waiter’s tip-

Upper nerve roots effected (C5-C6):

Loss of - Shoulder abduction, External rotation, Elbow flexion, supination

Producing - Adducted, internal rotated shoulder.

Extended and pronated forearm

Answer 161

A

Senosry - medial 1.5 fingers

Motor - intrinsic muscle weakness.

Manifests as clawing of 4th and 5th digits

The clawing is more pronounced at this level as FDP is spared.

Answer 162

A

i)

Attaches proximally - Scaphoid (laterally) Psiform (medially)

Distally - Trapezoid (laterally) Hamate (medially)

ii) 1 neve + 10 tendons

Median nerve

4x FDS, 4x FDP, 1 x FPL, 1 x FCR

iii) Thenar eminence sensation supplied by - Palmar cutaneous nerve which is given off before the tunnel

Answer 163

A

Long Thoracic Nerve - C5-C7 Roots. Ser. Ant.

Dorsal Scapular Nerve- C5 Root. Rhomb/ Lev. Scap.

Nerve to Subclavius - C5-C6. Roots. Subclavius

Suprascapular Nerve - C5-C6. Sup. Trunk. Supraspin/Infraspin.

Upper Subscapular Nerve - C5/C6. Post. Cord. Subscapular.

Lower Susbcapular Nerve- C5/ C6. Post. Cord. Subscapular. + Teres Major

Medial cutaneous nerve of forearm- C8. Medial Cord.

Medial cutaneous nerve of arm - T1. Medial Cord.

Medial Pectoral nerve - C8-T1. Medial Cord. Pec Maj+ Min

Lateral Pectoral Nerve - C5-C7. lat. Cord. Pec Maj.

Thoracodorsal nerve - C5-C7. Post. Cord. Latisimmus Dorsi

Answer 164

A

Pleura Projects 2.5cm above the middle of the clavicle

Parietal Pleura is innervated by intercostal nerves/ phrenic nerve

Visceral pleura is innervated by the pulmonary plexus

Answer 165

A

2 x demifacet - Articulates with vertebra above and below

Tubercle - Articulates with transverse process of vertebra

Subcostal groove - Containing intercostal bundle (SUperiorly - vein, artery, nerve - inferiorly)

Atypical Ribs;

1. Has a single facet and an extra tubercle (Scalene tubercle)

10-12. Have a single facet (articulate with corresponding vertebra alone)

11-12. Have no tubercle

Answer 166

A

i) Extends from the sternal edge to mid-axillary line from T2-T6
ii) Mainly lateral thoracic artery. Also - Internal thoracic artery, posterior intercostals + thoracoacromial artery
iii) APICAL - Anterior/pectoral nodes, Poterior/subscapular, infraclavicular, central, apical, lateral/brachial

Medially - internal thoracic lymph nodes

Superficially - Contralateral breast + abdominal wall

Answer 167

A

i) arises from L1 abdominal aorta
ii) immediately behind pancreatic body
iii) Passes anteriot ti 3rd part duodenum and uncinate process of pancreas.

Answer 168

A

Skin

Camper’s Fascia

Scarpa’s Fascia

External Oblique Aponeurosis

Internal Oblique Muscle

Transversus Abdominis

Transversalis Fascia

Extraperitoneal Fat

Peritoneum

Answer 169

A

i) Retrocaecal, Pelvic, Subcaecal, Postileal, Preileal

ii) Three taenia coli converge at the caecum and form longitudinal muscle layer. Where they converge you can find the appendix

Answer 170

A

i) SMA - Inferior Mesenteric
MMA - Internal Iliac

IMA - Internal pudendal artery

ii) Innervation:

Parasympathetic - S2-S4 (nervi erigentes). Fullness sensation + relaxation of IAS

Sympathetic - Superior hypogastric plexus + lumbar splanchnic nerves. Pain + contraction of IAS

iii) Retroperitoneal

1st third - Covered by peritoneum anteriorly/laterally

2nd third - Covered by peritoneum laterlly

Final third - Extraperitoneal

iv) Sigmoid then rectal

Answer 171

A

CN III Palsy - Pupil down and out

Pupil dilated (Unopposed sympathetic activity as CNIII carries PNS fibers to the sphincter pupillae).
Ptosis (Dual innervation CNIII and sympathetic)

Horner’s Syndrome -

Ptosis
Pupil Constricted (loss of sympathetic nerve) (meosis)
Enopthalmos (and anhydrosis)

Answer 172

A

CN III - Sup. Rectus, Med. Rectus. Inf. Rectus, Inferior Oblique, Levator Palpebrae Superioris

CNIV - Superior Oblique

CN VI - Lateral Rectus

Answer 173

A

i) Medial Longitudinal Arch

Bones: Calcaneum, Talus, Navicular, 3 cuneiforms, medial 3 metatrsals

Ligaments - Interosseus/ spring

Muscles - FHL, FDL, FDB, TA, TP

ii) Lateral Longitudinal Arch

Bones: Calcaneum, Cuboid, lateral 2 metatarsals

Ligaments: Long and short plantar ligaments

Muscles; Peroneus Longus, FDL, FDB

iii) Transverse Arch

Bones - Base of all metatarsals

Ligaments - Interosseus

Muscles - Peroneus Longus,

Answer 174

A

Deep:

Interossei, PL + TP tendons
FHB, AH, FDMinimi
Quadratus PLantae, lumbricals. FHL, FDL tendons
Abductor Hallucis, Abductor Digiti Minimi, FDB

Most superficial

Answer 175

A

Pronator Teres

Answer 176

A

i) 3Bs Biceps, Brachialis, Brachioradialis

ii) Lateral - Brachioradialis

Medial- Pronator Teres

Superior- Imaginary line through the humeral epicondyles

Superficial - Bicipital Aponeurosis

Deep - Brachialis/Supinator

iii) Antecubital fossa -

(Medial to biceps tendon) - brachial art., median nerve, basilic vein. Medial cubitan vein.

Brach Art. -> Radial + Ulna art.

Answer 177

A

i) Anterior Superficial Forearm

Pronator Teres, FCR, FDS, PL, FCU

ii) Anterior Deep Forearm

FPL, FDP, Pronator Quadratus

iii) Posterior Superficial Forearm

Brachoradialis, ECRLong, ECRBrev, EDigit, EDMinim, ECUln, Anconeus

iv) Posterior Deep Forearm

Supinator, EPolB, Ext.Ind., AbdPolL, EPolL

Answer 178

A

Originates from the medial cord of the brachial plexus.

Travels post. to medial epicondyle of humerus
Passes between two heads of FCU to enter anterior compartment of the forearm.
Anters the the hand alongside Ulnar Art. Through Guyon’s Canal

Answer 179

A

FDP attached to distal phalanges

FDS attached to middle phalanges (splits to allow FDP tendon to pass through)

Answer 180

A

i) Thickening of the transversus abdominus as it attaches to the crest of the pubis.

ii) External Oblique - Inferiorly + Anteriorly (hands in pockets). Lower 6 intercostal nerves + Subcostal nerve

Internal Oblique - Inferiorly + Posteriorly ( hands in contralateral pocket). lower intercostal, iliohypogastric, ilioinguinal

iii) T10. Therefore pathology from ureters (also T10) Can radiate to testes. Furthermore testes pathology can radiate to umbilicus

Answer 181

A

Femoral Artery + Vein (Not the femoral nerve)

Answer 182

A

i)

anterolaterally - Vastus medialis

anteromedially - sarotorius

posteriorly - adductor longus + magnus

ii) SFA, Femoral Vein, Saphenous Nerve, Nerve to vastus medialis

iii) 2/3 along an imaginary line between ASIS and Adductor Tubercel

Answer 183

A

i) Carpal bones form the floor

Flexor retinaculum form the roof

ii) The distal wrist crease is the surface marking for the proximal flexor retinaculum
iii) 10 Tendons - 4 FDP 4 FDS 1 FPL 1 FCR

Median Nerve

Answer 184

A

i)

Lateral(radial) - Abductor Pollicis Longus/ Extensor Pollicis Brevis

Medial (Ulna) - Extensor Pollicis Longus

Floor - Scaphoid Bone /Trapezium / Base of 1st Metacarpal/ Radial Styloid Process

ii) Contents - Radial Art., Radial N., Cephalic Vein

iii) Predominantly from the dorsal/distal ridge via branch of the radial art. The rest of the bone is supplied by retrograde flow

Answer 185

A

i) Median Nerve in the hand innervates:

Lateral Lumbricals

Opponens Pollicis

Abductor Pollicis Brevis

Flexor Pollicis Brevis

ii)

Ulnar Nerve - Finger Abduction (resisted)

Median Nerve - Thumb Opposition (resisted)

iii) Lumbricals - Flex MCP and Extend IPs

iv) palmar interossei (4) - Adduct digits

dorsal interossei (5) - abduct digits

v) Bowstringing is prevent through a series of ligamentous pulleys:

Flexor Retinaculum

Cruciate and annular ligaments

Answer 186

A

Principally there are 6 compartments:(rad to uln)

Extensor Pollicis Brevis + Abductor Pol. Long
ECR L+ B
Extensor Pollicis Longus
Extensor Indicis Proprious, Extensor Digitorum Communis
Extensor Digiti Minimi
Extenor Carpi Ulnaris

Answer 187

A

Apex - Left Ventricle

Right - Right Atrium

Left - Left Ventricle

Inferior - Right + Left Ventricle

Front - Right Ventricle

Back - Left Atrium

Answer 188

A

Three Layers:

Outer Fibrous Pericardium - Attaches to central tendon of diaphragm + great vessels

Inner Serous Pericardium is divided into:

*Parietal** Serous
*Visceral** Serous

Answer 189

A

i) Atrioventricular Sulcus

ii) Anterior Interventricular Artery runs in the anterior interventricular groove

iii) After giving off the LAD the LCA continues as the L Circumflex Artery

iv) LCA - L Posterior Aortic Sinus (R Post. has no artery originating from it)

RCA - Anterior Aortic Sinus

Answer 190

A

i) It is on the crista terminalis of the right atrium
ii) Bimodal population distribution.

60% - RCA

40% - LCA

Answer 191

A

Coronary Sinus is formed from the great cardiac vein + Left Marginal vein over the left ventricle.

Coronary Sinus continues on receiving tributaries (posterior vein of LV, middle cardiac vein, small cardiac vein) and eventually drains into the right atrium between the tricuspid valve and IVC.

Anterior Cardiac Veins drain directly into the right atrium

Answer 192

A

Muscles attaching to the greater tuberosity

Supraspinatous
Infraspinatous
Teres Minor

Radial Nerve runs in the spiral groove in between the medial and lateral heads of the triceps

The biceps long head

lies in the intertubercular groove of the humerus.
originates from the supraglenopid tubercle

- attaches (alongside the short head biceps in a combined tendon) at the radial tuberosity (of the radius) + the bicipital aponeurosis

Describe relativity of the pectoralis major, teres major and latissimus dorsi attachments on the humerus:

Pec major attaches laterally on the intertubercular groove.
Latissimus Dorsi in the middle
Teres Major medially to latisimmius dorsi

Coracoiod Process Origin:

Short Head Biceps Brachii
Croacobrachialis

Answer 193

A

Medial surface of intercondylar area of the tibia –>

Lateral femoral condyle

Runs in a posterolateral direction from the intercondylar area of the tibia

Answer 194

A

6 Arteries

Superior - Medial and lateral genicular arteries

Inferior - Medial and lateral genicular arteries

Descending Genicular Arteries

Recurrent Anterior Tibial Arteries

Answer 195

A

Stabilises the patellar and knee joint in gait.

All quadriceps muscles:

Flex the hip joint

Extend the knee joint

Answer 196

A

Obturator Nerve (Posterior to L2-L4)

Femoral Nerve ( Anterior to L2-L4)

Answer 197

A

Origin - Ischial Tuberosity

Semitendinosis -

Large tendinous insertion

Semimmebranosis -

Most medial hamstring muscle

Membrane like insertion forming an aponeurosis

Answer 198

A

i) The Liver

Superior Right - T4 Costal Cartilage

Superior Left - Mid Clavicular line, T5 Costal cartilage

Inferior - T10 Costal Cartilage, Mid Axillary Line

ii) The Gallbladder

In the Transpyloric plane
In between the 9th costal cartilage and the lateral border of rectus muscle

Answer 199

A

i) Superior - Inferior liver edge

Medially - Common hepatic Duct

Laterally - Cystic Duct

ii) Contents - Cystic Artery + LN of Lund

iii) Courvosier’s Law - When there is obstructive jaundice and a palpable gallbladder, gallstones are not the cause

iv ) Referred Gallbladder Pain :

Kehr’s - Right shoulder Tip

Boas’ Sign - Scapula

Answer 200

A

1. Right Lobe 2. Left Lobe 3. Quadrate lobe

4. Round ligament of liver

5. Falciform ligament of liver 6. Caudate Lobe

7. IVC 8. CBD 9. Hep. A 10. Portal Vein

11. Cystic Duct 12. Hepatic Duct 13. Gallbladder

Answer 201

A

Pleura

Superiorly - 2.5 cm above the mid point of the medial clavicle —> Coming down the R+L pleura meet in the midline at the 2nd rib

Parasternally - Right goes down to the 6th rib. Left goes down to the 4th rib (space for the heart).

Going inferiorly -

8th - Mid clavicular line

10th - Mid axillary line

12th - posterior chest

(subtract two from each of these to get the corresponding lung level)

i) Oblique fissure - From T3 vertebra to 6th rib anteriorly

ii) Horizontal fisure (R Only) - 4th costal cartilage to fifth rib in mid axillary line

iii) T2 iv) T4/T5 v) T9

Answer 202

A

Bronchopulmonary segment: Bronchus, Artery, vein and lymphatics

Right:

10 Bronchopulmonary segments:

Upper Lobe - 3

Middle Lobe - 2

Lower lobe - 5

Left:

9/10 Bronchopulmonary segments

Upper Lobe - 4/5

Lower lobe - 5

Answer 203

A

5:

Primary Bronchus

Pulmonary Artery / Vein

Bronchial Artery / Vein

Lymph Nodes

Autonomic Nerves

Answer 204

A

i) Carotid Sheath, Prevertebral, Pretracheal, Investing layer of deep cervical fascia

ii) Carotid Sheath - CCA, IJV, CN X, Lymph Nodes (in the wall of the sheath is ansa cervicalis)

Prevertebral - Vertebral Column, Deep back muscles, prevertebral msucles (Levator scapulae, Splenius Capitis), scalene muscles, and subclavian artery + brachial plexus in lower neck region

Pretracheal - Thyroid gland, Oesophagus, Trachea, infrahyoid muscles

Investing Layer - Surrounds all of the deep cervical fascial compartments

Answer 205

A

1/3 of the way down SCM –> 1/3 of the way up Trapezius

Answer 206

A

i)

1st Third- Inferior Thyroid Artery

Deep Cervical LNs

2nd Third - Aorta

Para Aortic/ Pre arotic

3rd Third - Left Gastric Artery/ Inferior Phrenic

Coeilac nodes

ii)

*A** rch of aorta
*B** ronchus (Left)
*C** Left Atrium
*D** iaphragm

However the most norrow part is at the cricopharyngeus sphincter

iii) Originates at C6 level at the cricoid cartilage

iv) Upper third has skeletal muscle under voluntary control to assist swallowing

Answer 207

A

A functional Sphincter

- The high pressure zone is maintained by several factors including:

i) Acute angle of entry through diaphragm (Angle of His)
ii) Phreno-oesophageal ligamnet encircling the GOJ
iii) Mucosal folds found at the GOJ

Answer 208

A

i) Hiatus (Sliding or rolling

ii) Bogdalek

iii) Morgagni

iv) Tramatic/ Iatrogenic

Answer 209

A

Reversible Replacement of one differentiated cell type with another differentiated cell type.

Answer 210

A

i) L1

ii) Anterior to the renal arteries. The most posterior structure at the hilum are the ureters

iii) Gonadal Art+ Vein

Left ureter- Left Colic

Right Ureter- Right Colic + Ileocolic

Uterine Art.

iv) Originates at L5 (Joining of CIVs) and is crossed by the right CIA

v) Proximally - the aorta is posterior and on the left of the IVC.

Distally - distal aorta is anterior to and on the left of the IVC

Answer 211

A

Kidneys/ Adrenals

Ureters

Bladder

Pancreas (not tip or tail)

Duodenum (not 1st part)

Ascending + Descending Colon

IVC

Aorta

Vagina

Rectum

Answer 212

A

i) Superior- From tragus of ear forward to zygomatic arch.

Medial - From zygomatic arch arches down towards angle of mandible

Posterior / Lateral - Ascends wrapped around angle of mandible.

ii) Innervated by Auriculotemporal Nerve (V3) –> The branches orginiate from CN IX (PNS)

iii) SUP: CNVII, Retromandibular Vein (formed from max. vein + sup. temp. vein), External Carotid.

iv) Mechanical - Stones, Obstructed Duct. Infection- Mumps, bacteria, TB. Neoplasm. Autoimmune- Sjogrens, SLE, Sarcoid. Drug - Antipsychotics

v) CNVII Zyg. supplies Orbicularis Oculi

Answer 213

A

i) Coracoclavicular Ligament - Has two portions: Conoid and Trapezoid ligaments

ii) Coracoacromial ligament

iii) Atypical Synovial - has a disc but also partly resembles ball and socket

iv) Rhomboids - Dorsal Scapular Nerve ( C5 Nerve Root)

v) Serratus anterior - Lateral rotation/ protraction of scapula (C5-C7 Roots)

Answer 214

A

i) Proximal - Lateral border of first rib.

Distal - Inferior border of teres major

ii) Proximal to pec minor - Sup. Thoracic

Posterior to pec minor - Thoracoacromial, Lat. Thoracic

Distal to pec minor - Subscapular., P+A circumflex

Answer 215

A

i) Quadrangular Space:

Sup- Teres Minor/ Subscapularis

Inf- Teres Maj.

Med- Long Head Triceps

Lat - Humerus

Transmits - Axillary N. Post. Circumfl.

ii) Triangular Space:

Lateral- Long head Triceps

Sup. - Teres Minor

Inf. - Teres Major

Transmits- Circumflex Scapular Art.

iii) Triangular Interval:

Sup - teres major

Lateral- Lateral head tric.

Medial- Long head tricep

Transmits - Rad. Nerve + Profundi Brachii Art.

Answer 216

A

i) Coracoid Process (of the scapula palpable beneath the clavicle) - Short head biceps, Pec Minor, Coracobrachialis.

ii) Supraglenoid Tubercle - Long head biceps

iii) Infraglenoid tubercle - Long head triceps

iv) Acromion (Continuation of the spine of the scapula) - Deltoid + Trapezius

v) Greater Tuberosity - Supraspinatous, Infraspinatous, Teres Minor

vi) Lesser Tuberosity - Subscapularis

Answer 217

A

Origin -

Attaches to the scalene tubercle of the first rib - which is medially located on the posterior upper sruface

and

1st - 9th Ribs via series of slips

Insertion -

Medial border of scapula (Superior / Middle / Inferior insertions)

Answer 218

A

i) Sympathetic Trunk:

ii) Descends through carotid canal forming a plexus on ICA passing anterior to the first rib.

Descends just lateral to the vertebral bodies and passes behind median arcuate ligament to enter abdominal cavity.

iii) Formation of plexuses surrounding arteries or hitching on spinal nerves

Answer 219

A

i) Thoracic Duct lies anterior to the sympathetic trunk on the left side.

Passes into the thorax at the t12 aortic hiatus

ii) It drains lymph beneath the diaphragm and the left thorax (L Jugular, Mediastinal and subclavian trunks).

Drains into the L Brachiocephalic vein

iii) The right thorax has an independent route of drainage int the R brachiocephalic vein

Answer 220

A

i) Superior to Inferior:

Vein, Artery Nerve

On the underside of the superior rib inbetween the innermost and inner intercostal muscles

ii) 1st two - By the costocervical artery of the subclavian artery

Rest by the intercostal arteries (segmental)

iii) Internal Thoracic artery of the subclavian artery (supplies breasts too)

Answer 221

A

i) Mylohyoid nerve - Which is a branch of the inferior alveolar nerve (V3)

ii) Surrounds the muscle. Bulk is superficial to the muscle but there is a smaller portion deep to it

iii) Wharton’s Duct - Lies in between Mylohyoid (superficial to it) and Hypoglossus (Deep to it) and opens either side of the lingual frenulum

Lingual nerve and hypoglossal nerve are in close proximity.

iv) Marginal Mandibular Nerve - incision 2.5cm inferior to the mandible

Answer 222

A

i) Superior - 3rd Rib at Right Parasternal/ 2nd Rib at Left Parasternal

Inferior - 5th ICS Left Mid Clavicular Line/ 6th ICS Right Parasternal

ii) Anterior - Right Atrium + Right Ventricle

iii) Posterior - Left Atrium

iv) Right Atrium - Right Border of cardiac sillouhette

v) Left Ventricle - Left border of cardiac sillouhette

Answer 223

A

i) Superior - 2.5cm above medial third of clavicle

Meet at sternum –> then 4th rib seperate

8th rib - Mid - Clavicular

10th rib - Mid - Axillary

12th rib - Posterior

Note - R side of pleura descends 6th parasternally before moving off midline /

whereas L Side of pleura descends 4th parasternally before moving off midline

ii) Oblique Fissure:

3rd thoracic spine posteriorly –> 6th Costocondral Junction ANteriorly

iii) Horizontal Fissure:

Oblique Fissure in mid axillary line –> Fourth Costal Cartilage (only on right)

Answer 224

A

i) Posterior Cricoarytenoid - Opens the vocal cords

ii) Lateral Cricoarytenoid - Close the vocal cords

iii) Thyroarytenoids - Reduce tension in vocal cord

iv) cricothyroids - Increase tension in vocal cord

v) Strap Muscles function to depress hyoid and larynx:

Ansa Cervicalis (C1-C3 originating from cervical plexus. Content of the carotid sheath) - Sternothyroid, Sternohyoid, Omohyoid

C1 - Thyrohyoid

Answer 225

A

Sensory:

Internal Laryngeal Nerve - Sensation above vocal Cords

Recurrent Laryngeal Nerve - Sensation below vocal cords

Motor:

External Laryngeal Nerve- Cricothyroid

Recurrent Laryngeal Nerve - Everything else

Answer 226

A

Hyoid Bone - C3

Thyroid Cartilage - C4

Cricoid Cartilage - C6

Note the cervical levels also correspond with which pharyngeal arch they originate from.

Answer 227

A

i) They are found posterior to the thyroid gland (two on each side)

ii) Superior Parathyroids - from the 4th Pharygneal Arch

Inferior Parathyroids - from the 3rd Pharyngeal ARch

iii) Blood supply is solely from the inferior thyroid artery

Answer 228

A

i) Internal urethral sphincter -

Continuous with bladder musculature. Continuous circular smooth muscles

External urethral sphincter -

Below the prostate in the deep perineal pouch.

Comprised of rectourethralis muscle + levator ani muscle

ii) Ejaculatory ducts open onto each side of the Prostatic utricle (blind ended pouch)

Answer 229

A

Skin

Subcutaneous Fascia

Dartos Fascia

External Spermatic Fascia

Cremasteric Fascia

Internal Spermatic Fascia

Tunica Vaginalis (pouch of serous membrane covering testicle. Vagination of the peritoneum. Remnant of the route of descent of testes - processes vaginalis )

Tunica Albuginea (fibrous covering of the testes)

Answer 230

A

Common peroneal Nerve - L4-S2

Sural Communicating Nerve - Aids the sural nerve. Posterolatearl leg

Lateral Sural Communicating Nerve - Upper Lateral Leg

Terminal branches:

Sup peroneal Nerve - Dorsum of foot

Deep Peroneal nerve - First Web Space

Answer 231

A

i) C4 - just inferior to hyoid bone
ii) Carotid Canal

Answer 232

A

i) Arteries: Dorsal arteries, Deep Arteries, Bulbourethral Artery (all from internal pudendal artery)

ii) Veins: Superficial and Deep Dorsal Veins - Drain into the prostatic venous plexus

iii) Neves: Dorsal nerve of the penis (Pudendal Nerve) - Sympathetic and sensory

Peri-prostatic nerve plexus (parasympathetic)

Answer 233

A

Femoral Artery

Femoral Vein

Femoral branch of the genitofemoral nerve

Lymphatics (+Lymph node of Cloquet)

Answer 234

A

i) Innervation - L5+S1

ii) Origin - Iliac Crest

Insertion - Iliotibial Band

iii) Acts synergistically with the - Gluteus Maximus, Gluteus Medius, Gluteus Minimus

Answer 235

A

i) arises from the superior colliculus of the midbrain

ii) Occulomotor Nerve Nucleus (superior colliculus of the midbrain) - PNS

Edinger Westphal Nucleus (Superior colliculus of the midbrain) - PNS

Answer 236

A

i) Carotid Body - is a chemoreceptor in adventitia of the bifurcation of CCA

Responds to hypoxia, hypercapnea and increased pH –> Increased BP/HR + RR
Has two cell types - Chief Cells + Substentacular Cells

ii) Carotid Sinus - Carotid bulb of internal carotid artery.

Baroreceptor

iii) Aortic Body - Chemoreceptors present along the aortic arch

Answer 237

A

i) Phimosis - Inability to retract foreskin over the glans.

ii) Mechanical - Narrow foreskin, Fusion of forekin with glans, Short frenulum

Inflammatory - Balnitis, Lichen Sclerosus or balanatis xerotica obliterans, repeated catheterisation

Answer 238

A

PNS - Otic Ganglion (Originally tympanic nerve [CN IX branch] –> form lesser petrosal nerve after tympanic plexus in middle ear –> go to otic ganglion —> Auriculotemporal Nerve to Parotid Gland )

SNS - Superior Cervical Ganglion

Sensory- Greater Auricular Nerve

Answer 239

A

Facial Nerve (Mandibular Nerve is well seperated from the gland)

Retromandibular Vein

Auriculotemporal nerve ( Branch of V3)

External Carotid Artery

Answer 240

A

Sympathetic - superior cervical ganglion

Parasympathetic - submandibular ganglion via lingual nerve

Arterial Supply - Facial ARtery

Venous Drainage - Anterior Facial Vein

Lymph - Deep Cervical + Jugular

Answer 241

A

Lacrimal - Greater petrosla nerve (VII) to the pterygopalatine gaglion. Then lacrimal (V1) to the gland

Submandibular/Sublingual - Chorda Tympani (VII) to the lingual nerve (V3) to the submandibular ganglion

Parotid - Glossopharyngeal nerve (IX) to Leseer petrosal nerve –> Otic Ganglion –> Auriculotempral Nerve (V3)

Warton’s Duct/Lingual Nerve seperates the sublingual gland from the frenulum of tongue

The Stylomandibular ligament seperates the submandibular and parotid gland

Answer 242

A

Anterior

Transverse spinous processes C3-C6 -> First Rib (Scalene Tubercle)

Innervated Anterior Ramiof C5 - C6

Anterior to Anterior Scalene - Subclavian Vein + Phrenic Nerve

Middle

Transverse spinous processes C2-C7 -> First Rib (Scalene Tubercle)

Innervated anterior rami of C3-C8

Between anterior and middle scalene - Subclavian Artery and brachial plexus

Posterior

Transverse spinous processes C5-C7 -> Second Rib

Innervated anterior rami of C6-C8

Answer 243

A

At the Wrist: (Guyon’s Canal)

Muscles affected - Medial two lumbricals, Adductor Pollicis, Interossei muscles

Claw - Hyperextension of MCPs, Hyperflexion of DIPs

At the elbow: (Cubital Canal)

Muscles affected - Lateral two lumbricals, adductor pollicis, itserossei muscles, Lateral, FDP, FCU (Variable)

Claw - Hyperextension of MCPs, The claw is often less severe as the FDP is not spared and therefore doesnt contribute to hyper flexion of the IPs.

Answer 244

A

i) Piriformis + Obturator Internus

ii) Pelvic Floor Muscles - Levator Ani, Coccygeus

iii) Levator Ani is made up of 3 distinct muscles (innervated by Pudendal Nerve):

Puborectalis (+prerectal fibers) - Pubic Bones past the urogenital hiatus to the rectal hiatus which it surrounds. Prerectal fibers are very important in maintaining urinary continence

Pubococcygeus - Immediately lateral to puborectalis. Arise from pubic bones and attach to the coccyx/anococcygeal ligament

Iliococcygeus - from ischial spines to coccyx/anococcygeal ligament

Answer 245

A

Supra-Elbow - Hand of Bennediction (On trying to make a fist)

Intrinsic hand muscle loss: Loss of thumb opposition/ Abduction/ Lateral two lumbricals/ Flexor pillicis brevis

Loss of Pronation (with arm extended) + Loss of wrist flexion

Appearance - Hand of bennediction - on trying to make fist the Lateral three digits are un able to flex due to loss of FDP, FDS.

Ape Hand - This refers to the adducted thumb position resultant throm loss of abductor pollicis longus and wasted thenar aminence

Answer 246

A

Superior - Fourth Pharyngeal Arch

Inferior - Third Pharyngeal Arch

Answer 247

A

I - Trigeminal

II - Facial

III - Glossopharyngeal

IV - Vagus

VI - Vagus + RLN

Answer 248

A

Coccygeus

Ischial Spines –> Lateral Sacrum, Coccyx, Sacrospinous Ligament

Innervation - Anterior Rami of S4+S5

Answer 249

A

i) Anatomical

Anterior - Pubic Symphsis Posterior - Coccyx

Lateral - Inferior Ischial + Pubic Rami, Sacro tuberous ligament

Roof - Pelvic Floor Floor - Skin and fascia

(Divided into urogenital and anal triangless by a line through the ischial tuberosities)

Surface

Anterior - Mons Posterior - Intergluteal cleft Lateral - Medial thigh

ii) Anal Orifice, External Anal Sphincter, Ischioanal fossae (either side of anal orifice inferior to pelvic diaphragm )

Answer 250

A

Dural Venous Sinuses

Spinal nerve roots

connective tissue

Answer 251

A

i) Deep Perineal Pouch - Between the pelvic floor (deep) and the perineal membrane (superficial)

Men - Urethra, External urethral sphincter, bulbourethral glands, transverse perineal muscle

Women - Urethra, External urethral sphincter, vagina

Superficial Perineal Pouch - Between the perineal membrane (deep) and the Deep perineal “Colles’” fascia (superficial)

Laterally - Corpus Cavernosus (Crus of clitoris/penis), Medially - Corpus Spongiosum. Ischocavernosus, Bulbospongiosus, Superficial Transverse perineal muscle.

ii) In women - the vagina and ureter go through the perineal membrane

Answer 252

A

Pudendal Nerve + Internal Pudendal Artery

Course along the ischial tuberositeis within a thickening of obturator fascia called “Alcock’s Canal”.

Then travels through each Ischioanal fossa (lateral to the anal orifice between the pelvic diaphragm and skin)

Answer 253

A

It is an irregular fibromuscular mass acting as a point of attachment for various structures.

Location - Junctional between urogenital and anal triangles.

Attachments -

Levator Ani

Bulbocavernosus

Transverse perineal muscles (deep+superficial)

External Anal Sphincter

Internal Anal sphincter

Answer 254

A

Dorsalis Pedis (From the Anterior Tibial Artery)

Enters the foot anteriorly over the tarsal bones then moves inferiorly to the sole anastamosing with the lateral plantar artery

Posterior Tibial Artery

Enters sole of foot through tarsal tunnel and contributes to medial and lateral plantar artery

Deep Plantar Arch - gives off common plantar digital arteries to the digits

Derived from both medial and lateral plantar artery.

Medial plantar artery also provides plantar digital artery to the hallux.

Lateral plantar artery also proves plantar digital artery to the fifth toe

Answer 255

A

Portal Venule, Hepatic Arteriole + Bile Duct

Answer 256

A

What level does the pulmonary trunk divide?

T5

How many cusps does the pulmonary valve have?

3- Anterior, Left + Right

What is the pulmonary ligament

Sheet of parietal + Visceral pleura extending from the medial surface of the lower lobe to the mediastinum just inferior to the hilum

Allows expansion of hilar vessels in times of increased cardiac output

Structures of the hilum:

Vein is most anterior

Answer 257

A

i) Xiphisternum

7-12th Ribs

Lumbar Vertebrae (left and right crura)

Central Tendon - Attached to the fibrous pericardium

ii) Central Tendon: IVC + R Phrenic Nerve

iii) Hepatoduodenal ligament contains the porta hepatis

iv) Quadrate Lobe:

R- Gallbladder Fossa

L- Umbilical Vein Fossa

Posterior - Porta Hepatis

Answer 258

A

The arcuate line is a:

Horizontal line 1/2 been umbilicus and the pubic crest.

Demarcates the end of the posterior rectus sheath + where the inferior epigastric vessels perforate the rectus abdominus

Above the arcuate line:

Anterior Rectus Sheath - External oblique aponeruosis + Anteria lamina of internal oblique aponeurosis

Posterior Recuts Sheath - Posterior lamina of internal oblique aponeurosis + tranverses abdominus aponeuoriss

Below the arcutate line :

Anterior REctus sheath - combination of EOA, IOA + TAA

Behind this the rectus abdominus is in direct contact with the transversalis fascia

Answer 259

A

i) Midgut Derived Structures:

Superior Mesenteric Plexus - Approximates well to the SMA –> axxompanying it into the mesentery where it divides to give secondary plexi.

It is a continuation of the coeliac plexus (Receives an extra branch from the R Vagus)

Hindgut derived Structures:

Inferior Mesenteric Plexus :

PNS - Pelvic Splanchnic Nerves

SNS - Lumbar Splanchnic Nerves

ii) Coeliac plexus - From the greater + lesser splanchnic nerves and anterior and posterior vagal trunks

—> gives off hepatic, pancreatic, splenic, gastric, suprarenal plexi, renal, gonadal and superior mesenteric plexus.

Answer 260

A

Distal -> Proximal

L5 - Two CIV Join

L5- Median Sacral Vein

L5-L3 - Lumbar Veins

L3 - Right Gonadal Vein

L2 - Renal Veins

L2/L1 - Right Suprarenal Vein

T12 - Inferior Phrenic, Left/Middle/Right Hepatic Veins

Answer 261

A

Arterial:

Superior - Inferior Phrenic

Middle - Abdominal Aorta

Inferior - Renal Artery

Venous:

Left Adrenal Vein –> Renal Vein –> IVC

Right Adrenal Vein —> IVC

Answer 262

A

i) Extends from T1-L2

ii) Communicates with spinal neves through rami communicantes

Answer 263

A

i) Behind 1st/2nd Part - Gastroduodenal Artery

ii) Behind 3rd Part - Aorta / IVC

iii) Anterior to third part - SMA / SMV

iv) Behind Fourth Part- Left Renal vein

Answer 264

A

i) Diploic veins are found in between the inner and outer layer of cranial bones and drain into the various intracranial sinuses
ii) Deep temporal artery - Branch of maxillary artery

Answer 265

A

i) Thoracic Duct Drains into the left subclavian vein (Croses behind the oesophagus from right to left at the vertebral level T4)

Right Thoracic Duct/ Subclavian Duct/ Jugular Duct all drain into the Right subclavian vein

ii) Azyguos Vein Drains into the Superior Vena Cava

Answer 266

A

Small Cardiac Vein - Right Coronary Artery

Middle Cardiac Vein - Posterior Interventricular Artery

Great cardiac vein - Anterior Interventricular Artery

Answer 267

A

1) Vastus Muscles (Med, Intermedialis, Lat) all originate from the

intertrochanteric Line

Lat- Superiorly

Medialis - Inferiorly

Interm - In between

2) OSIQ

Oburator Internus

Superior Gemellus

Inferior GEmellus

Quadratus Femoris

all originate from the Ischial Tuberosity in that order

and insert onto the greater trochanter

Answer 268

A

The Extensor Digitorum Tendons:

Flatten as they reach the metacarpophalangeal joints forming a hood

and then

Medial Band attaches to the middle phalanx

Two Lateral Bands attach to the distal phalanx

Function - compound tendinous attachment for the extensor digitiorum, lumbricals and interossei muscles

Answer 269

A

A tumour of mesenchymal origin

arising from smooth muscle pacemaker cells of kajal

Mutations in the KIT gene

They have a low malignant potential compared to other GI tumours

KIT - encodes a Tyrosine Kinase like transmembranous receptor:

Leads to phosphorylation of ADP

–> In turn leading to various effects acting like and on/off switch —> Enzyme changes, Cellular proliferation signalling.

Answer 270

A

Interbercular Groove –> Clavicle + Sternum

Clavicular - Flexion

Sternum - Adduction

Also accessory muscle of inspiration

Answer 271

A

Superior - Splenic ARtery

Inferior - Third part of duodenum, DJ Flexure

Anterior - Stomach, Gastro duodenal artery (to head)

Posterior to body - SMA, AOrta,

Posterior to neck - IVC SMV

Answer 272

A

Through Mastoid Air Cells causing local bony erosions.

OR

Cholesteatoma leading to bone erosion

Temporal Abscess / Meningitis

Sigmois Sinus Thrombosis

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Anatomy Flashcards

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